Department of Gastrointestinal Oncology, Laboratory of Carcinogenesis and Translational Research of the Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China.
Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, China.
Int J Cancer. 2023 Dec 1;153(11):1885-1893. doi: 10.1002/ijc.34543. Epub 2023 Jun 9.
Formal multidisciplinary team (MDT) discussions in clinical practice require time and space but have unclear survival benefits for advanced gastrointestinal cancer patients. Our study aimed to investigate the long-term survival of patients with advanced gastrointestinal cancer after MDT decision. From June 2017 to June 2019, continuous MDT discussions on advanced gastrointestinal cancer were conducted in 13 medical centers in China. MDT decisions and actual treatment received by patients were prospectively recorded. The primary endpoint was the difference in overall survival (OS) between patients in the MDT decision implementation and nonimplementation groups. The secondary endpoints included the implementation rate of MDT decisions and subgroup survival analysis. A total of 461 MDT decisions of 455 patients were included in our study. The implementation rate of MDT decisions was 85.7%. Previous treatment had an impact on MDT decision-making. The OS was 24.0 months and 17.0 months in the implementation and nonimplementation groups, respectively. The implementation of MDT decisions significantly reduced the risk of death in multivariate analyses (hazard ratio = 0.518; 95% confidence interval: 0.304-0.884, P = .016). Subgroup analysis showed a significant difference in survival of patients with colorectal cancer, but not in survival of patients with gastric cancer. The rate of secondary MDT discussion was only 5.6% among patients who the MDT decisions were discontinued due to changes in their condition. MDT discussion can prolong the OS of patients with advanced gastrointestinal cancer, especially those with colorectal cancer. Timely scheduling of the subsequent MDT discussion is necessary when the disease condition changes.
多学科团队（MDT）讨论在临床实践中需要时间和空间，但对晚期胃肠道癌患者的生存获益尚不清楚。我们的研究旨在调查晚期胃肠道癌患者接受 MDT 决策后的长期生存情况。 从 2017 年 6 月至 2019 年 6 月，在中国的 13 家医疗中心连续进行了晚期胃肠道癌的 MDT 讨论。前瞻性记录了 MDT 决策和患者实际接受的治疗。主要终点是 MDT 决策实施组和非实施组患者总生存（OS）的差异。次要终点包括 MDT 决策的实施率和亚组生存分析。 本研究共纳入 455 例患者的 461 次 MDT 决策。MDT 决策的实施率为 85.7%。既往治疗对 MDT 决策有影响。实施和非实施组的 OS 分别为 24.0 个月和 17.0 个月。多变量分析显示，实施 MDT 决策显著降低了死亡风险（风险比=0.518；95%置信区间：0.304-0.884，P=0.016）。亚组分析显示，结直肠癌患者的生存存在显著差异，但胃癌患者的生存无差异。由于病情变化而停止 MDT 决策的患者中，仅有 5.6%的患者进行了二次 MDT 讨论。MDT 讨论可以延长晚期胃肠道癌患者的 OS，尤其是结直肠癌患者。当病情变化时，有必要及时安排后续的 MDT 讨论。
