Zhang Huaqi, Yu Jishang, Wei Zhewei, Wu Wenhui, Zhang Changhua, He Yulong
Digestive Disease Center, Seventh Affiliated Hospital of Sun Yat-Sen University.
Gastrointestinal Surgery Center, First Affiliated Hospital of Sun Yat-Sen University.
J Cancer. 2021 Apr 7;12(11):3307-3314. doi: 10.7150/jca.56171. eCollection 2021.
The effects of multidisciplinary team discussion intervention on the treatment and prognosis of advanced colorectal cancer are still controversial. Large sample size studies to evaluate the efficacy in patients with advanced colorectal cancer are lacking. We statistically analyzed the data of surgical patients diagnosed with advanced colorectal cancer from 2008 to 2014 by retrospective analysis. Patients were divided into two groups according to whether or not they received multidisciplinary team discussion intervention. After at least 3 years of follow up, differences between two groups were compared with respect to treatment process and patient prognosis. The time to treatment in intervention group was shorter (9.6 ± 4.2 days vs 10.7 ± 5.6 days; p= 0.002). There were no significant differences in recurrence and metastasis rate between the two groups. Multivariate survival analysis suggested that multidisciplinary team discussion intervention reduced the risk of death (HR = 0.677; p = 0.006). And it had significant interaction with tumor invasion and tumor stage, and especially had beneficial effects in the tumor stage IV subgroup (p=0.005) and tumor invasion T4 subgroup (p<0.001). Multidisciplinary team discussion intervention accelerated the treatment process and reduced the death risk of patients with advanced colorectal cancer, especially improved the overall survival of stage IV and invasion T4 patients. The clinical characteristics of tumor invasion and tumor stage must be the primary considerations when judging whether patients need to conduct multidisciplinary team discussions.
多学科团队讨论干预对晚期结直肠癌治疗及预后的影响仍存在争议。目前缺乏大样本量研究来评估其对晚期结直肠癌患者的疗效。我们通过回顾性分析,对2008年至2014年诊断为晚期结直肠癌的手术患者数据进行了统计学分析。根据患者是否接受多学科团队讨论干预将其分为两组。经过至少3年的随访,比较两组在治疗过程和患者预后方面的差异。干预组的治疗时间较短(9.6±4.2天 vs 10.7±5.6天;p = 0.002)。两组的复发和转移率无显著差异。多因素生存分析表明,多学科团队讨论干预降低了死亡风险(HR = 0.677;p = 0.006)。并且它与肿瘤浸润和肿瘤分期有显著交互作用,尤其对肿瘤分期IV亚组(p = 0.005)和肿瘤浸润T4亚组(p<0.001)有有益影响。多学科团队讨论干预加快了治疗进程,降低了晚期结直肠癌患者的死亡风险,尤其改善了IV期和浸润T4期患者的总生存期。在判断患者是否需要进行多学科团队讨论时,肿瘤浸润和肿瘤分期的临床特征必须作为首要考虑因素。