Department of Respiratory Diseases and Allergy, Aarhus University Hospital (AUH), Aarhus N, DK-8200, Denmark.
The Danish Lung Cancer Group, Odense University Hospital (OUH), Odense, DK-5000, Denmark.
BMC Cancer. 2024 Nov 18;24(1):1423. doi: 10.1186/s12885-024-13188-4.
This study aimed to evaluate the consistency of lung cancer case assessments across multidisciplinary team (MDT) sites in Denmark. The goal was to appraise the comparability of outcomes between hospitals in a real-world context.
We prepared sixty comprehensive, fictitious lung cancer case stories, complete with images, and distributed them to the four primary lung cancer MDT conferences in Denmark. These cases were subsequently evaluated as had they been ordinary patients during regular MDT meetings. We compared the conclusions on assigned TNM stage and proposed treatment intent using Kappa statistics.
The consensus on assigned stage (Stages IA-B, IIA-B, IIIA-B, IV, and undetermined) corresponded to a Fleiss' Kappa-value of 0.62 (95% CI: 0.52-0.71). The overall assessment of curability, categorized as Curable, Incurable, and Undetermined, corresponded to a Kappa-value of 0.72 (CI: 0.61-0.84). However, for cases unanimously judged by all MDT sites to be Stage III, the concordance on treatment intent was poor, with an agreement coefficient of only 0.32 (95% CI: -0.27-0.97).
In detail, the level of agreement on assigned stages was less than desired. In consequence, comparative analyses of treatment results from different hospitals or centres may be prone to bias caused by systematic differences in stage assessment or intent of treatment. The least consensus was observed for cases in Stage III, indicating a need for quality improvement efforts to ensure a higher degree of consistency in MDT decisions.
本研究旨在评估丹麦多学科团队（MDT）站点间肺癌病例评估的一致性。目标是评估真实环境下医院间结果的可比性。
我们准备了 60 个全面的、虚构的肺癌病例故事，附有图像，并分发给丹麦的四个主要肺癌 MDT 会议。这些病例随后在常规 MDT 会议期间作为普通患者进行评估。我们使用 Kappa 统计比较分配的 TNM 分期和建议的治疗意向的结论。
在分配的阶段（IA-B、IIA-B、IIIA-B、IVA 和未确定）上的共识对应 Fleiss' Kappa 值为 0.62（95%CI：0.52-0.71）。可治愈性的总体评估，分为可治愈、不可治愈和未确定，对应 Kappa 值为 0.72（CI：0.61-0.84）。然而，对于所有 MDT 站点一致判断为 III 期的病例，治疗意向的一致性较差，仅为 0.32（95%CI：-0.27-0.97）。
详细来说，分配阶段的一致性低于预期。因此，不同医院或中心的治疗结果的比较分析可能容易受到分期评估或治疗意向的系统差异引起的偏差的影响。对于 III 期病例的一致性最低，表明需要进行质量改进努力，以确保 MDT 决策有更高程度的一致性。
