摘要
目的:了解多学科协作(multidisciplinary team,MDT)模式下直肠癌术后肺转移治疗决策现状和结局,为加强医疗质量管理、完善MDT模式提供依据。方法:回顾性收集2007年7月至2015年2月北京大学肿瘤医院680例接受术前新辅助治疗联合根治术的直肠癌患者临床资料,调查术后发生肺转移的患者在MDT模式下的治疗决策、执行情况和生存结局。结果:研究纳入85例术后肺转移患者,68例采用MDT模式治疗,其中28例建议行局部根治,40例建议行姑息治疗;决策总执行率为89.7%(61/68),未执行者均选择进一步保守治疗。局部根治的患者在直肠原发灶术后首次发生复发/转移后的3年复发/转移后生存率(survival after recurrence,SAR)高于姑息治疗患者(84.8%vs.37.6%,P<0.001)。结论:在MDT模式运行良好的情况下,直肠癌根治术后肺转移的治疗决策执行率较高,部分患者在该模式下有机会获得根治且预后良好;引入“患者参与”和“社会支持”将有助于构建全新MDT模式和提高医疗质量管理水平。
Objective:To investigate the treatment strategies and outcomes of pulmonary recurrence after total mesorectal excision for rectal cancer in a multidisciplinary team(MDT)model and enhance health care quality management.Methods:This retrospective cohort study,conducted from July 2007 to February 2015 at Peking University Cancer Hospital(PKUCH)identified 680 patients with mid-low rectal cancer who received neoadjuvant chemoradiation in combination with total mesorectal excision.We investigated MDT treatment decisions,the final implementation,and survival outcomes of patients with pulmonary recurrence who entered the MDT model.Results:We identified 85 patients with metachronous pulmonary recurrence.Of these,68 patients were treated within the MDT model at PKUCH.For 28 patients,local treatment with a curative intent was recommended.The other 40 patients received palliative treatment or supportive care.Of the 68 MDT decisions,61(89.7%)were implemented.Discordance arose in instances where patients received a more conservative treatment than what was originally recommended.The estimated 3-year survival after recurrence(SAR)rate was significantly different between patients who received curative versus palliative treatment(84.8%vs.37.6%,P<0.001).Conclusions:We observed a high concordance between MDT decisions and final implementation in patients with pulmonary rences after total mesorectal excision of rectal cancer.Considerable pulmonary recurrence can be treated with a curative intent,and good outcomes can be achieved through the MDT model used at PKUCH.Patients'participation and social support may contribute to the development of a new MDT model and lay the foundation for enhancing medical quality management.
作者
孙婷婷
王林
陈鹏举
武爱文
Tingting Sun;Lin Wang;Pengju Chen;Aiwen Wu(Key laboratory of Carcinogenesis and Translational Research(Ministry of Education),Department of Gastrointestinal Cancer Center,Unit III,Peking University Cancer Hospital&Institute,Beijing 100142,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2019年第22期1139-1144,共6页
Chinese Journal of Clinical Oncology
基金
国家自然科学基金(编号:81773214)资助。
关键词
直肠癌
肺转移
多学科协作
新辅助放化疗
决策
rectal cancer
pulmonary recurrence
multidisciplinary team
neoadjuvant chemoradiotherapy
decision making
