独立多学科工作对印度尼西亚3期和4期鼻咽癌生存率的影响：一项回顾性队列研究
Impact of independent multidisciplinary work on the survival rate of stage 3 and 4 nasopharyngeal cancer in Indonesia: a retrospective cohort study.
作者信息
Rizky Daniel, Yunarvika Vina, Putra Yasjudan R, Pangarsa Eko A, Kartiyani Ika, Panunggal Damianus G, Hutajulu Susanna H, Setiawan Budi, Hariadi Kartika W T, Santosa Damai, Herdini Camelia, Yoshuantari Naomi, Dhamiyati Wigati, Purwanto Ibnu
机构信息
Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital.
Division of Hematology-Medical Oncology, Department of Internal Medicine.
出版信息
Ann Med Surg (Lond). 2023 Jul 20;85(9):4248-4255. doi: 10.1097/MS9.0000000000001074. eCollection 2023 Sep.
BACKGROUND
The utilization of a multidisciplinary team (MDT) strategy is a beneficial approach in integrating the knowledge and proficiencies of various fields to produce thorough and advantageous cancer treatment plans for patients. Nevertheless, MDT has yet to be widely adopted in Indonesia. In this study, the authors examined an early form of MDT in Indonesia that does not involve dedicated meetings, referred as independent multidisciplinary work (IMW). The objective is to investigate the differences in survival rates of nasopharyngeal cancer (NPC) patients who underwent treatment with and without IMW.
MATERIALS AND METHODS
This study has a retrospective cohort design. Data were collected from the medical records of newly diagnosed stage 3 and 4 NPC patients between 2016 and 2018. The subjects were divided into two groups: the IMW group and the non-IMW group. The primary end point of the study is overall survival rate between the two groups. Kaplan-Meier survival analysis, log-rank test, and cox proportional hazard analysis were used for statistical analysis.
RESULTS
This study included a total of 124 patients with NPC, 81 patients in the IMW group and 43 patients in the non-IMW group. At the end of the 36-month follow-up period, the median survival of the IMW group was not reached, while in the non-IMW, it was 12 months [95% confidence intervals (95% CI), 8.78-15.22], hazard ratio (HR): 0.47 (95% CI, 0.28-0.78; <0.01). The 1-year survival rate was 66.7% in the IMW group versus 46.5% in the non-IMW group (HR=0.7, 95% CI 0.49-0.99; =0.03); the 2-year survival rate was 40.7% in the IMW group versus 16.3% in the non-IMW group (HR=0.4, 95% CI 0.19-0.83; <0.01). Daniel Rizky, Vina Yunarvika, and Yasjudan Rastrama Putra, these authors contributed equally to this work. In the multivariate analysis, the IMW approach, ECOG (The Eastern Cooperative Oncology Group) status, distant metastasis, and treatment approach were significantly associated with survival outcome.
CONCLUSION
The use of IMW approach in the treatment of NPC was associated with a better survival outcome compared to non-IMW treatment.
背景
采用多学科团队（MDT）策略是一种有益的方法，可整合各个领域的知识和技能，为患者制定全面且有益的癌症治疗方案。然而，MDT在印度尼西亚尚未得到广泛应用。在本研究中，作者考察了印度尼西亚一种早期形式的MDT，即不涉及专门会议的独立多学科工作（IMW）。目的是调查接受IMW治疗和未接受IMW治疗的鼻咽癌（NPC）患者的生存率差异。
材料与方法
本研究采用回顾性队列设计。数据收集自2016年至2018年新诊断的3期和4期NPC患者的病历。研究对象分为两组：IMW组和非IMW组。本研究的主要终点是两组之间的总生存率。采用Kaplan-Meier生存分析、对数秩检验和Cox比例风险分析进行统计分析。
结果
本研究共纳入124例NPC患者，IMW组81例，非IMW组43例。在36个月的随访期结束时，IMW组的中位生存期未达到，而非IMW组为12个月[95%置信区间（95%CI），8.78 - 15.22]，风险比（HR）：0.47（95%CI，0.28 - 0.78；<0.01）。IMW组的1年生存率为66.7%，非IMW组为46.5%（HR = 0.7，95%CI 0.49 - 0.99；= 0.03）；IMW组的2年生存率为40.7%，非IMW组为16.3%（HR = 0.4，95%CI 0.19 - 0.83；<0.01）。丹尼尔·里兹基、维娜·尤纳尔维卡和亚斯朱丹·拉斯特拉马·普特拉，这些作者对本工作贡献相同。在多变量分析中，IMW方法、东部肿瘤协作组（ECOG）状态、远处转移和治疗方法与生存结果显著相关。
结论
与非IMW治疗相比，采用IMW方法治疗NPC与更好的生存结果相关。
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