多学科团队质量改善局部进展期直肠癌患者的生存结局：STELLAR 试验的事后分析。

Multidisciplinary team quality improves the survival outcomes of locally advanced rectal cancer patients: A post hoc analysis of the STELLAR trial.

机构信息

State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.

出版信息

Radiother Oncol. 2024 Nov;200:110524. doi: 10.1016/j.radonc.2024.110524. Epub 2024 Sep 5.

DOI:10.1016/j.radonc.2024.110524

PMID:39243864

Abstract

PURPOSE

We sought to determine the association between multidisciplinary team (MDT) quality and survival of patients with locally advanced rectal cancer.

METHODS

In a post hoc analysis of the randomized phase III STELLAR trial, 464 patients with distal or middle-third, clinical tumor category cT3-4 and/or regional lymph node-positive rectal cancer who completed surgery were evaluated. Disease-free survival (DFS) and Overall survival (OS) were stratified by Multidisciplinary team (MDT) quality, which was also included in the univariable and multivariable analyses of DFS and OS.

RESULTS

According to the univariable analyses, a significantly worse DFS was associated with a fewer specialized medical disciplines participating in MDT (<5 vs ≥ 5; P=0.049),a lower frequency of MDT meetings (<once a week vs ≥ once a week; P=0.021) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; P=0.039). In addition, a lower number of specialized medical disciplines participating in MDT (<5 vs ≥ 5; P<0.001), a lower frequency of MDT meetings (<once a week vs ≥ once a week; P<0.001) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; P=0.001) were the variables associated with OS. These 3 factors were considered when assessing MDT quality, which was classified into 2 categories: high quality or general quality. Patients treated in hospitals with high MDT quality had longer 3-year OS (90.5 % vs 78.1 %; P=0.001) and similar 3-year DFS (70.3 % vs 61.3 %; P=0.109) compared to those treated in hospitals of the general MDT quality group. Furthermore, multivariable analyses revealed a significance for DFS (HR, 1.648; 95 % CI, 1.143-2.375; P=0.007) and OS (HR, 2.771; 95 % CI, 1.575-4.877; P<0.001) in MDT quality.

CONCLUSIONS

The use of hospitals with optimized multidisciplinary infrastructure had a significant influence on survival of patients with locally advanced rectal cancer.

摘要

目的

我们旨在确定多学科团队（MDT）质量与局部晚期直肠癌患者生存之间的关系。

方法

在 STELLAR 试验的事后分析中，对完成手术的 464 名远端或中三分之一、临床肿瘤类别 cT3-4 和/或区域淋巴结阳性的直肠癌症患者进行评估。无病生存（DFS）和总生存（OS）根据多学科团队（MDT）质量进行分层，MDT 质量也包括在 DFS 和 OS 的单变量和多变量分析中。

结果

根据单变量分析，与 MDT 中参与的专业医学学科较少（<5 与≥5；P=0.049）、MDT 会议频率较低（<每周一次与≥每周一次；P=0.021）和 MDT 年度直肠癌讨论量较小（≤200 与>200；P=0.039）显著相关的 DFS 较差。此外，MDT 中参与的专业医学学科较少（<5 与≥5；P<0.001）、MDT 会议频率较低（<每周一次与≥每周一次；P<0.001）和 MDT 年度直肠癌讨论量较小（≤200 与>200；P=0.001）与 OS 相关。这些 3 个因素在评估 MDT 质量时被考虑在内，MDT 质量被分为 2 类：高质量或一般质量。在 MDT 质量较高的医院接受治疗的患者，3 年 OS 率（90.5%与 78.1%；P=0.001）较长，3 年 DFS 率（70.3%与 61.3%；P=0.109）相似，而在 MDT 质量一般的医院接受治疗的患者。此外，多变量分析显示 MDT 质量对 DFS（HR，1.648；95%CI，1.143-2.375；P=0.007）和 OS（HR，2.771；95%CI，1.575-4.877；P<0.001）有意义。