线上和线下联合的癌症多学科综合治疗协作组诊疗模式探讨

Discussion on online and offline combined multidisciplinary team diagnosis-treatment mode for cancers

目的通过对比线上和线下两种多学科综合治疗协作组(MDT)诊疗模式制定的综合诊疗方案,探讨采用线上和线下联合的癌症MDT诊疗模式的可行性。方法以2020年3月17日至2020年5月17日山东省肿瘤医院采用线上和线下MDT诊疗模式的168例食管癌患者为研究对象,评价线上和线下MDT诊疗模式制定的综合诊疗方案的一致性,并分析综合诊疗方案不同患者的临床特征,如年龄、Karnofsky功能状态(KPS)评分、是否合并基础疾病、入院前是否接受抗肿瘤治疗及肿瘤位置,从而探讨如何在保证质量的基础上,提高MDT诊疗模式效率。结果线上和线下MDT诊疗模式制定的综合诊疗方案一致的比例为86.3%(145/168)。综合诊疗方案不一致的病例特征表现为高龄(>69岁)(χ^(2)=4.250,P=0.039)、KPS评分≥80分(χ^(2)=15.520,P<0.001)及合并基础疾病(χ^(2)=7.135,P=0.008)。进一步分析发现,综合诊疗方案不一致的病例还表现为辅助检查不完善及影像学疑难的特征。结论线上和线下联合的癌症MDT诊疗模式是可行的。对于高龄(>69岁)、KPS评分≥80分、合并基础疾病、辅助检查不完善或影像学疑难的病例,应采用或补充线下MDT诊疗模式讨论。

Objective To discuss the feasibility of using online and offline combined multidisciplinary team(MDT)diagnosis-treatment mode in cancers diagnosis and treatment by comparing the comprehensive diagnosis and treatment plans formulated by online and offline MDT diagnosis-treatment mode.Methods A total of 168 esophageal cancer patients collected from March 17,2020 to May 17,2020 were took as the research objects in Shandong Cancer Hospital and Institute,through whom the consistency of the comprehensive diagnosis and treatment plans formulated by online and offline MDT diagnosis-treatment mode was evaluated.The clinical characteristics of patients with changed comprehensive diagnosis and treatment plans,such as age,Karnofsky performance status(KPS)score,whether combined with basic diseases,whether received anti-tumor treatment before and tumor location were analyzed,so as to explore the mechanism to improve the efficiency on the basis of quality assurance.Results The results showed that 86.3%(145/168)of the comprehensive diagnosis and treatment plans obtained by offline MDT diagnosis-treatment mode were consistent with online diagnosis-treatment MDT mode.Cases with inconsistent comprehensive diagnosis and treatment plans were characterized by elderly(>69 years)(χ^(2)=4.250,P=0.039),KPS score≥80(χ^(2)=15.520,P<0.001)and combined with underlying disease(χ^(2)=7.135,P=0.008).Through further analysis,the changed cases were also characterized as with inadequate auxiliary examination or complex in imaging.Conclusion The online and offline combined MDT diagnosis-treatment mode is feasible.For the patients characterized of elderly(>69 years old),KPS score≥80,combined with underlying diseases,with incomplete auxiliary examination or complex in imaging,the offline MDT diagnosis-treatment mode should be adopted or supplemented.