多学科团队在胃肠道神经内分泌肿瘤综合诊治中的应用

Implementation of multidisciplinary team in the diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasm

在肿瘤治疗领域，多学科协作组（MDT）模式已广为世界各国所接受。不同专科人员的参与增进了各学科间的交流和沟通．提高了肿瘤诊断和治疗的效率。神经内分泌肿瘤（NEN）是起源于肽能神经元和神经内分泌细胞的一类具有异质性的肿瘤．胃肠胰神经内分泌肿瘤（GEP-NEN）是最常见的类型。由于GEP-NEN发病率较低，对这类疾病的认识经历了漫长的过程，目前仍处于起步探索阶段，存在许多尚未解决的问题困扰临床医生。NEN的高度异质性和复杂性，需要个体化诊治，诊断需要影像学、核医学、病理、检验等多学科合作．治疗涉及手术、化疗、放疗、介入及肽受体放射性核素治疗（PRRT）等多种方式，需要院内或院际MDT讨论制定规范个体化治疗计划，最大限度整合多学科资源，以达到提高生活质量和延长生存的目的。北京大学肿瘤医院已于2013年成立了NEN多学科协作组，包括内科、外科、病理、核医学、介入及影像等学科。本文结合我院多年来GEP-NEN多学科协作组开展的临床经验，对MDT在GEP-NEN综合治疗中的应用进行阐述。

Multidisciplinary team （MDT） has been considered as the best practice in the treatment planning and care for patients with cancer around the world. With the increased range and number of specialists involved, multidisciplinary coordination and communieation have been enhanced, and the efficiency and quality of diagnosis and treatment of cancer have been imp rpved. Neuroendocrine neoplasm （NEN） is a heterogeneous group of tumors originating from neuroendocrine cells located throughout the body, most of which is gastroenteropancreatic neuroendoerine neoplasm （GEP-NEN）. Due to the low incidence of GEP-NEN, the knowledge of such rare disease went through a long way of exploration, and a large number of unresolved issues still plagued the clinicians. An effective diagnosis of GEP-NEN requires a multimodal approach that combines evaluation of clinical symptoms and hormone levels, radiologieal and nuclear imaging, and histological confirmation. The treatment is complex, including surgery, oncology, radiotherapy,peptide receptor radionuclide treatment （PRRT） and interventional therapy, so MDT model should play an important role in the diagnosis and treatment of GEP-NEN to maximize the integration of multidisciplinary resources and improve the life quality as well as survival. A NEN-MDT was organized in 2013 by the Beijing Cancer Hospital, including oncology, surgery, pathology, nuclear medicine and radiology. This paper investigates the significance and management in the implementation of MDT model in the diagnosis and treatment of GEP-NEN, based on the experience of MDT operation in our center.