Chen Yonghe, Xiang Jun, Liu Dan, Xiao Jian, Xiong Fei, Wei Kaikai, Liu Aihong, Chen Shi, Zhu Yaxi, Meng Xiaochun, Peng Junsheng
Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, China.
J Cancer. 2021 Jan 30;12(7):1907-1914. doi: 10.7150/jca.53365. eCollection 2021.
Previous studies proposed that the multidisciplinary team (MDT) consultation could improve tumor staging accuracy and outcomes of patients with gastric malignancy. However, evidence-based reports remain limited. This study aimed to determine the effectiveness of MDT for tumor staging accuracy and outcomes of patients with resectable gastric cancer, and to explore the potential factors affecting its effectiveness. This retrospective study enrolled 719 gastric cancer patients who underwent gastrectomy in our hospital. After propensity score matching, 378 patients were selected, including 189 in the non-MDT group and 189 in the MDT group. Data regarding baseline characteristics, staging, treatments, and survival were analyzed. The data showed that the staging accuracy in the MDT group and non-MDT group was comparable (53% vs 61% for T stage, 46.1% vs 35.3% for N stage, and 78.3% vs 78.7% for M stage). The MDT group had a higher proportion of preoperative chemotherapy (39.2% vs 28%, p=0.03) and laparoscopic surgery (82.5% vs 72%, p=0.02) than the non-MDT group. However, the achievement of R0 resection was similar in the two groups (93.7% vs 88.9%, p=0.73). There was no significant difference in the 1-year and 3-year overall survival rates between the two groups. Moreover, we observed poor patient compliance when the MDT recommended further examinations, radiotherapy, or chemotherapy before surgical interventions. MDT consultation has limited effects on improving the staging accuracy and treatment outcomes including survival of patients with resectable gastric cancer. Poor patient compliance may be a factor affecting the effectiveness of MDT consultation.
既往研究表明，多学科团队（MDT）会诊可提高胃恶性肿瘤患者的肿瘤分期准确性及改善其预后。然而，基于证据的报告仍然有限。本研究旨在确定MDT对可切除胃癌患者肿瘤分期准确性及预后的有效性，并探索影响其有效性的潜在因素。这项回顾性研究纳入了我院719例行胃切除术的胃癌患者。经过倾向评分匹配后，选取了378例患者，其中非MDT组189例，MDT组189例。分析了有关基线特征、分期、治疗及生存的数据。数据显示，MDT组与非MDT组的分期准确性相当（T分期分别为53%和61%，N分期分别为46.1%和35.3%，M分期分别为78.3%和78.7%）。MDT组术前化疗（39.2%对28%，p=0.03）和腹腔镜手术（82.5%对72%，p=0.02）的比例高于非MDT组。然而，两组R0切除的完成情况相似（93.7%对88.9%，p=0.73）。两组1年和3年总生存率无显著差异。此外，我们观察到当MDT在手术干预前建议进一步检查、放疗或化疗时，患者依从性较差。MDT会诊对提高可切除胃癌患者的分期准确性及包括生存在内的治疗效果影响有限。患者依从性差可能是影响MDT会诊有效性的一个因素。
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