Quero Giuseppe, De Sio Davide, Fiorillo Claudio, Menghi Roberta, Rosa Fausto, Massimiani Giuseppe, Laterza Vito, Lucinato Chiara, Galiandro Federica, Papa Valerio, Salvatore Lisa, Bensi Maria, Tortorelli Antonio Pio, Tondolo Vincenzo, Alfieri Sergio
Pancreatic Surgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Agostino Gemelli, Rome, Italy.
Gemelli Pancreatic Advanced Research Center (CRMPG), Università Cattolica del Sacro Cuore di Roma, Rome, Italy.
Front Surg. 2023 Feb 17;10:1119557. doi: 10.3389/fsurg.2023.1119557. eCollection 2023.
The introduction of multidisciplinary tumor boards (MDTBs) for the diagnostic and therapeutic pathway of several oncological disease significantly ameliorated patients' outcomes. However, only few evidences are currently present on the potential impact of the MDTB on pancreatic cancer (PC) management. Aim of this study is to report how MDTB may influence PC diagnosis and treatment, with particular focus on PC resectability assessment and the correspondence between MDTB definition of resectability and intraoperative findings.
All patients with a proven or suspected diagnosis of PC discussed at the MDTB between 2018 and 2020 were included in the study. An evaluation of diagnosis, tumor response to oncological/radiation therapy and resectability before and after the MDTB was conducted. Moreover, a comparison between the MDTB resectability assessment and the intraoperative findings was performed.
A total of 487 cases were included in the analysis: 228 (46.8%) for diagnosis evaluation, 75 (15.4%) for tumor response assessment after/during medical treatment, 184 (37.8%) for PC resectability assessment. As a whole, MDTB led to a change in treatment management in 89 cases (18.3%): 31/228 (13.6%) in the diagnosis group, 13/75 (17.3%) in the assessment of treatment response cohort and 45/184 (24.4%) in the PC resectability evaluation group. As a whole, 129 patients were given indication to surgery. Surgical resection was accomplished in 121 patients (93.7%), with a concordance rate of resectability between MDTB discussion and intraoperative findings of 91.5%. Concordance rate was 99% for resectable lesions and 64.3% for borderline PCs.
MDTB discussion consistently influences PC management, with significant variations in terms of diagnosis, tumor response assessment and resectability. In this last regard, MDTB discussion plays a key role, as demonstrated by the high concordance rate between MDTB resectability definition and intraoperative findings.
多学科肿瘤委员会（MDTBs）被引入多种肿瘤疾病的诊断和治疗途径，显著改善了患者的治疗效果。然而，目前关于MDTB对胰腺癌（PC）治疗的潜在影响的证据很少。本研究的目的是报告MDTB如何影响PC的诊断和治疗，特别关注PC可切除性评估以及MDTB可切除性定义与术中发现之间的一致性。
本研究纳入了2018年至2020年间在MDTB讨论过的所有经证实或疑似诊断为PC的患者。对MDTB前后的诊断、肿瘤对肿瘤学/放射治疗的反应以及可切除性进行了评估。此外，还对MDTB可切除性评估与术中发现进行了比较。
共有487例病例纳入分析：228例（46.8%）用于诊断评估，75例（15.4%）用于药物治疗后/期间的肿瘤反应评估，184例（37.8%）用于PC可切除性评估。总体而言，MDTB导致89例（18.3%）的治疗管理发生变化：诊断组中31/228例（13.6%），治疗反应评估队列中13/75例（17.3%），PC可切除性评估组中45/184例（24.4%）。总体而言，129例患者被建议进行手术。121例患者（93.7%）完成了手术切除，MDTB讨论与术中发现的可切除性一致率为91.5%。可切除病变的一致率为99%，临界PC的一致率为64.3%。
MDTB讨论持续影响PC的治疗，在诊断、肿瘤反应评估和可切除性方面存在显著差异。在最后这方面，MDTB讨论起着关键作用，MDTB可切除性定义与术中发现之间的高一致率证明了这一点。
