Li J A, Xu Y L, Ding N, Ji Y, Liu L X, Rao S X, Zhang Y Q, Yao X Z, Fan Y, Huang C, Zhou Y H, Wu L L, Dong Y, Zhang L, Rong Y F, Kuang T T, Xu X F, Liu L, Wang D S, Jin D Y, Lou W H, Wu W C
Department of Pancreatic Surgery,Zhongshan Hospital Fudan University,Shanghai 200032,China.
Department of Pathology,Zhongshan Hospital Fudan University,Shanghai 200032,China.
Zhonghua Wai Ke Za Zhi. 2022 Jul 1;60(7):666-673. doi: 10.3760/cma.j.cn112139-20220408-00149.
To evaluate the role of pancreas multidisciplinary team(MDT) clinic in the diagnosis of pancreatic diseases,patient compliance with MDT advice,and the impact of MDT on the postoperative survival of patients with pancreatic cancer. The study included 927 patients(554 males,373 females,aged (58.1±13.3)years (range: 15 to 89 years)) that had visited the pancreas MDT clinic of Zhongshan Hospital from May 2015 to December 2021,and 677 patients(396 males, 281 females, aged (63.6±8.9)years(range: 32 to 95 years)) who underwent radical surgery and with pathologically confirmed pancreatic adenocarcinoma from January 2012 to December 2020,of whom 79 patients had attended the pancreas MDT. The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. The Kaplan-Meier method was used for drawing the survival curve and calculating the survival rate. The univariate analysis was done by Log-rank test and the multivariate analysis was done by COX proportional hazards model. Survival rates were compared using χ test. Among the 927 patients that had visited the MDT clinic,233 patients(25.1%) were referred due to undetermined diagnosis. A direct diagnosis was made in 109 cases (46.8%,109/233) by the MDT clinic, of which 98 were consistent with the final diagnosis,resulting in an accuracy of 89.9%(98/109). The direct diagnosis rate in the recent years(36.6%(41/112),from June 2019 to December 2021) decreased compared to that in the previous years(56.2%(68/121),from May 2015 to May 2019),yet the accuracy in the recent years(90.2%,37/41) was basically the same as before (89.7%,61/68). The rate of compliance of the entire cohort was 71.5%(663/927), with the compliance rate in the recent two and a half years(81.4%,338/415) remarkably higher than that in the previous four years(63.4%,325/512). Patients with pancreatic cancer that attended the MDT exhibited a trend toward longer median postoperative survival than patients that did not attend the MDT,but the difference was not statistically significant(35.2 months 30.2 months,>0.05). The 1-year and 3-year survival rates of patients that attended the MDT were significanly higher than patients that did not attend the MDT(88.6% 78.4%,<0.05;32.9% 21.9%,<0.05,respectively),but the 5-year survival rate was not statistically different(7.6% 4.8%,>0.05). The pancreas MDT clinic is an accurate and convenient way to diagnose intractable pancreatic diseases,and in the recent years the patients' compliance rate with MDT advice has increased. Pancreatic cancer patients that have attended the MDT have higher 1-year and 3-year postoperative survival rates,but the long-term survival benefits of MDT still needs to be proved by clinical studies on a larger scale.
为评估胰腺多学科团队(MDT)门诊在胰腺疾病诊断中的作用、患者对MDT建议的依从性以及MDT对胰腺癌患者术后生存的影响。该研究纳入了2015年5月至2021年12月期间就诊于中山医院胰腺MDT门诊的927例患者(男性554例,女性373例,年龄(58.1±13.3)岁,范围:15至89岁),以及2012年1月至2020年12月期间接受根治性手术且病理确诊为胰腺腺癌的677例患者(男性396例,女性281例,年龄(63.6±8.9)岁,范围:32至95岁),其中79例患者曾参加胰腺MDT门诊。对临床和病理数据进行回顾性收集和分析。疾病根据2010年世界卫生组织消化系统肿瘤分类及常规临床实践进行分类。采用Kaplan-Meier法绘制生存曲线并计算生存率。单因素分析采用Log-rank检验,多因素分析采用COX比例风险模型。生存率比较采用χ检验。在927例就诊于MDT门诊的患者中,233例(25.1%)因诊断不明而被转诊。MDT门诊直接诊断出109例(46.8%,109/233),其中98例与最终诊断一致,准确率为89.9%(98/109)。近年来(2019年6月至2021年12月)的直接诊断率(36.6%(41/112))较前几年(2015年5月至2019年5月)的56.2%(68/121)有所下降,但近年来的准确率(90.2%,37/41)与之前(89.7%,61/68)基本相同。整个队列的依从率为71.5%(663/927),近两年半的依从率(81.4%,338/415)显著高于前四年(63.4%,325/512)。参加MDT的胰腺癌患者术后中位生存期有长于未参加MDT患者的趋势,但差异无统计学意义(35.2个月对30.2个月,P>0.05)。参加MDT的患者1年和3年生存率显著高于未参加MDT的患者(分别为88.6%对78.4%,P<0.05;32.9%对21.9%,P<0.05),但5年生存率无统计学差异(7.