多学科协作模式在结直肠癌肝转移治疗中应用的探讨

Application of multidisciplinary treatment in patients with liver metastasis of colorectal cancer

目的探讨多学科协作模式（MDT）在结直肠癌肝转移（CLM）诊治中的应用。方法回顾分析2014年2月至2015年4月解放军总医院收治的结直肠癌肝转移患者118例的临床资料，其中经结直肠癌多学科协作组诊治32例（MDT组），未经MDT讨论86例（对照组），比较两组术前检查和辅助治疗的顺应性及疗效相关指标。结果（1）MDT组患者接受影像检查的比例明显高于对照组：胸部CT为87．5％（28／32）比40．7％（35／86）（P=0．000）；腹部MRI为84．4％（27／32）比61．6％（53／86）（P=0．019）；盆腔MRI为63．7％（7／11）比24．3％（8／33）（P=0．017）。MDT组TNM分期影像学评估率100％，高于对照组的20．9％（18／86）（P=0．000）；但两组TNM分期准确率差异无统计学意义[81．3％（26／32）比66．7％（12／18），P=0．246]。（2）MOT组患者术前化疗率90．6％（29／32），高于对照组的62．8％（54／86）（P=0．003）；化疗完成率MDT组82．8％（24／29），对照组57．4％（31／54），差异亦有统计学意义（P=0．000），但两组间初始不可切除CLM患者的转化率比较，差异无统计学意义[24．0％（6／25）比14．3％（7／49），P=0．299]。（3）MDT组患者一期切除或消融术的比例为76．9％（10／13），对照组则为36．0％0（9／25），差异有统计学意义（P=0．0382）；MDT组转移灶手术切除率为77．0％（20／26），对照组则为44．9％（13／29），差异亦有统计学意义（P=0．015）；但两组R0切除率、切缘阳性率、淋巴结清扫率、转移灶清扫率及病理完全缓解率和术后并发症发生率及术后化疗率方面比较，差异均无统计学意义（均P〉0．05）。结论MDT模式有利于规范CLM患者的术前检查和围手术期化疗，提高患者的一期切除或消融术率及转移灶的手术切除率。

Objective To evaluate the application of muhidisciplinary treatment （MDT） in patients with liver metastasis of colorectal cancer （CLM）. Methods Clinical data of 118 patients with liver metastasis of colorectal cancer, including 32 patients with MDT （MDT group） and 86 patients without MDT （control group）, from February 2014 to April 2015 in PLA General Hospital were analyzed retrospectively. Compliance of preoperative examination and adjuvant therapy, and efficacy- associated indexes were compared between the two groups. Results （1） As compared to control group, statistically significant increase in imaging examination ratio was found in MDT group： chest CT [87.5%（28/32） vs. 40.7%（35/86）, P= 0.0000], abdominal MRI [84.4%（27/32） vs.61.6%（53/86）, P= 0.019], pelvic MRI [63.7%（7/11） vs. 24.3%（8/33）, P= 0.017]. The preoperative assessment of TNM staging was also higher in MDT group [ 100%（32/32） vs. 20.9%（18/86）, P = 0.0000], while there was no significant difference in accuracy rate of TNM staging between the two groups [81.3%（26/32） vs. 66.7%（12/18）, P= 0.2465 ]. （2） Rates of preoperative chemotherapy and chemotherapy completion were also higher in MDT group than those in control group [90.6%（29/32） vs. 62.8%（54/86）, P= 0.0033; 82.8% （24/29） vs. 57.4% （31/54）, P= 0.000], but conversion rate of unresectable CLM showed no significant difference [24.0% （6/25） vs. 14.3% （7/49）, P = 0.299 ]. （3） Rate of onestage resection or ablation was higher in MDT group compared to control group [76.9%（10/13） vs. 36.0% （9/25）, P = 0.038], and resection rate of metastasis nidus was also higher in MDT group [77.0% （20/26） vs. 44.9%（13/29）, P= 0.015]. No significant differences were observed in rates of R0 resection, positive surgical margin, lymph node clearance, ablation of metastasis nidus, pathological complete response, postoperative chemotherapy or postoperative complications （all P〉 0.05）. Conclusion MDT has the advantages on standardization of preoperative examination and perioperative chemotherapy, and can improve the rate of one-stage resection or ablation, as well as resection of metastasis nidus.