多学科协作模式对局部进展期直肠癌诊治及预后的影响

Effects of multidisciplinary team mode on diagnosis, treatment and prognosis of locally advanced rectal cancer

目的:探讨多学科协作(MDT)模式对局部进展期直肠癌(LARC)诊治及预后的影响。方法:回顾性分析26例依据MDT模式进行诊疗(MDT组)和同期75例未行MDT(对照组)的LARC患者的临床资料,比较两组患者的治疗过程及预后。结果:MDT组术前T4期患者比例高于对照组(P<0.05);两组其他基线特征比较,差异无统计学意义(P>0.05)。与对照组相比,MDT组术前接受新辅助化疗与放疗的患者比例更高(P<0.001)。两组术后住院时间、吻合口瘘和排尿困难发生率、病理类型、脉管癌栓患者比例、转移淋巴结数、清扫淋巴结数、远侧切缘距肛门距离、术后放化疗患者比例差异均无统计学意义(P均>0.05)。MDT组低位(肿瘤下缘距肛缘距离<5 cm)直肠癌患者保肛率11/13,高于对照组的19/36(P<0.05)。两组总生存曲线、无进展生存曲线差异无统计学意义(P>0.05)。结论:MDT模式能够使LARC患者的治疗更加规范化,提高低位直肠癌患者的保肛率,提高患者生活质量。

Aim:To investigate the effect of multidisciplinary team(MDT)mode on the diagnosis,treatment and prognosis of locally advanced rectal cancer(LARC).Methods:Clinical data of LARC patients,including 26 cases received MDT(MDT group)and 75 cases without MDT discussion(control group)were retrospectively collected.The treatment and prognosis of the two groups were compared.Results:The proportion of preoperative Stage T4 patients in the MDT group was higher than that in the control group(P<0.05),while there was no significant differences in the other baseline characteristics between the two groups(P>0.05).Compared with the control group,the proportion of patients receiving preoperative neoadjuvant chemotherapy and radiotherapy was higher in MDT group(P<0.001),and there were no statistical differences between the two groups in terms of surgical data,such as postoperative hospital stay,anastomotic fistula,dysuria,pathological type,vessel carcinoma embolus,number of metastatic lymph nodes,number of dissected lymph nodes,distance from the surgical margin,or proportion of postoperative chemoradiotherapy(P>0.05).The anal retention rate of the low rectal cancer(the lower edge of the tumor less than 5 cm from the anal margin)patients of MDT group was 11/13,higher than that(19/36)of the control group(P<0.05).There were no significant differences in the OS or PFS survival curves between the two groups(P>0.05).Conclusion:MDT diagnosis and treatment mode can make the treatment of locally advanced rectal cancer patients more standardized,improve anal sphincter preservation rate of patients with low rectal cancer,and improve the quality of life.