Jestin Hannan Christine, Risso Solange León, Lindblad Mats, Loizou Louiza, Szabo Eva, Edholm David, Bartholomä Wolf Claus, Åkesson Oscar, Lindberg Fredrik, Strandberg Sara, Linder Gustav, Hedberg Jakob
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgery, Visby lasarett, Visby, Sweden.
BJS Open. 2024 Oct 29;8(6). doi: 10.1093/bjsopen/zrae140.
There are differences in oesophageal cancer care across Sweden. According to national guidelines, all patients should be offered equal care, planned and administrated by regional multidisciplinary team meetings. The aim of the study was to investigate differences between regional multidisciplinary team meetings in Sweden regarding clinical staging and treatment recommendations for oesophageal cancer patients.
All six Swedish regional multidisciplinary teams were each invited to retrospectively include ten consecutive oesophageal cancer cases. After anonymization, radiological investigations were presented, along with the original case-specific medical history, anew at the participating regional multidisciplinary team meetings. Estimation of clinical tumour node metastasis (TNM) classification and treatment recommendation (curative, palliative or best supportive care) were compared between multidisciplinary team meetings as well as with original assessments.
Five multidisciplinary teams participated and contributed a total of 50 cases presented to each multidisciplinary team. In estimations of cT-stage, the multidisciplinary teams were in total agreement in only eight of 50 cases (16%). For cN-stage, total agreement was seen in 17 of 50 cases (34%) and for cM-stage there was agreement in 34 cases (68%). For cT-stage, the overall summarized κ value was 0.57. For N-stage and M-stage the κ values were 0.66 and 0.78 respectively. Differences in appraisal were not associated with usage of positron emission tomography-computed tomography. In 15 of 50 cases (30%) the multidisciplinary teams disagreed on curative or palliative treatment.
The study shows differences in assessment of clinical TNM classification and treatment recommendations made at regional multidisciplinary team meetings. Increased interrater agreement on clinical TNM classification and management plans are essential to achieve more equal care for oesophageal cancer patients in Sweden.
瑞典各地的食管癌护理存在差异。根据国家指南，所有患者都应获得由区域多学科团队会议规划和管理的平等护理。本研究的目的是调查瑞典各区域多学科团队会议在食管癌患者临床分期和治疗建议方面的差异。
邀请瑞典所有六个区域多学科团队各自回顾性纳入连续的10例食管癌病例。在匿名化之后，将放射学检查结果以及原始的特定病例病史在参与的区域多学科团队会议上再次展示。比较多学科团队会议之间以及与原始评估之间对临床肿瘤淋巴结转移（TNM）分类的估计和治疗建议（治愈性、姑息性或最佳支持治疗）。
五个多学科团队参与并总共提供了50例病例，每个多学科团队各有50例。在cT分期的估计中，多学科团队在50例病例中仅有8例（16%）完全一致。对于cN分期，50例中有17例（34%）完全一致，对于cM分期，有34例（68%）一致。对于cT分期，总体汇总的κ值为0.57。对于N分期和M分期，κ值分别为0.66和0.78。评估差异与正电子发射断层扫描-计算机断层扫描的使用无关。在50例病例中有15例（30%）多学科团队在治愈性或姑息性治疗上存在分歧。
该研究显示了区域多学科团队会议在临床TNM分类评估和治疗建议方面存在差异。提高临床TNM分类和管理计划的评分者间一致性对于瑞典食管癌患者获得更平等的护理至关重要。
