Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Dis Esophagus. 2024 Oct 28;37(11). doi: 10.1093/dote/doae061.
Multidisciplinary team meetings (MDTs) are recommended for patients with esophageal cancer. Improved staging, timeliness to surgery and better adherence to guidelines have been attributed to MDTs, but there are few studies published on the MDTs' effect on survival. All patients with esophageal cancer in Sweden between 2006 and 2018 were grouped according to whether they had been discussed at an MDT as part of their clinical pathway. Factors affecting group allocation were explored with multivariable logistic regression, and the impact of MDT on survival was studied with Cox-regression and the Kaplan-Meier estimator. Of 6837 included patients, 1338 patients (20%) were not discussed at an MDT. Advanced age (80-90 years; odds ratio [OR] 0.25, 0.16-0.42 (95% confidence interval)) and clinical stage IVb (OR 0.65, 0.43-0.98) decreased the probability of being presented at an MDT, whereas high education level (OR 1.31, 1.02-1.67), being married (OR 1.20, 1.01-1.43), squamous histology (OR 1.50, 1.22-1.84) and later year of diagnosis (OR 1.33, 1.29-1.37 per year) increased the probability of an MDT. In multivariable adjusted analysis, MDT discussion was associated with improved survival (hazard ratios 0.72, 0.66-0.78) and median survival increased from 4.5 to 10.7 months. MDTs were associated with improved survival for esophageal cancer patients. Elderly patients with advanced disease and poor socioeconomic status were less likely to be presented at an MDT, but had clear survival-benefits if they were discussed in a multidisciplinary setting.
多学科团队会议（MDTs）推荐用于治疗食管癌患者。MDTs 可改善分期、手术及时性和更好地遵循指南，但发表的关于 MDT 对生存影响的研究较少。2006 年至 2018 年间，所有在瑞典的食管癌患者均根据其是否在临床路径中进行 MDT 讨论进行分组。采用多变量逻辑回归探讨影响分组的因素，并采用 Cox 回归和 Kaplan-Meier 估计器研究 MDT 对生存的影响。在纳入的 6837 例患者中，有 1338 例（20%）未在 MDT 中讨论。高龄（80-90 岁；比值比 [OR] 0.25，0.16-0.42（95%置信区间））和临床 IVb 期（OR 0.65，0.43-0.98）降低了在 MDT 中出现的可能性，而高教育水平（OR 1.31，1.02-1.67）、已婚（OR 1.20，1.01-1.43）、鳞状组织学（OR 1.50，1.22-1.84）和较晚的诊断年份（OR 1.33，每年 1.29-1.37）增加了 MDT 的可能性。在多变量调整分析中，MDT 讨论与改善生存相关（风险比 0.72，0.66-0.78），中位生存时间从 4.5 个月增加到 10.7 个月。MDTs 与食管癌患者的生存改善相关。患有晚期疾病和较差社会经济地位的老年患者不太可能在 MDT 中出现，但如果在多学科环境中进行讨论，则具有明显的生存获益。
