卵巢癌单病种多学科协作模式的临床实践效果分析

Clinical practice of the single-disease MDT strategy in ovarian malignancies

目的通过分析中山大学肿瘤防治中心卵巢癌单病种多学科协作(multi-disciplinary team,MDT)会诊的开展情况,评价MDT模式在卵巢癌临床实践中的作用。方法回顾2017年6月至2019年6月参加中山大学肿瘤防治中心卵巢癌单病种MDT会诊的连续性患者队列,分析临床资料、MDT会诊决策内容、执行情况和随访结果。统计学分析采用SPSS 22.0。结果在入组的243例患者中,原发性卵巢癌203例,其中诊断为Ⅰ~Ⅱ期5例(5/203,2.5%),Ⅲ~Ⅳ期85例(85/203,41.9%),复发性113例(113/203,55.7%);组织学类型为上皮性肿瘤171例(171/203,84.2%)。全部病例共进行265例次讨论,建议化疗236例次(236/265,89.1%),其中203例次(203/236,86.0%)执行化疗,184例次(184/203,90.6%)达到预期疗效,与未执行者相比差异有统计学意义(90.6%vs.45.5%,P<0.001);建议手术治疗154例次(154/265,58.1%),其中145例次(145/154,94.2%)执行手术,143例次(143/145,98.6%)达到预期疗效,与未执行者相比差异有统计学意义(98.6%vs.33.3%,P<0.001);建议其他治疗168例次(168/265,63.4%),其中112例次(112/168,66.7%)执行建议,95例次(95/112,84.8%)达到预期疗效,与未执行者相比差异有统计学意义(84.8%vs.33.9%,P<0.001)。结论MDT模式在卵巢癌患者的病情评估、治疗方案布局以及全程管理等临床实践环节中发挥重要作用,可以明显改善近期治疗效果。但由于随访时间及病例数有限,卵巢癌单病种MDT对患者远期预后的影响有待进一步探索。

Objective To evaluate the clinical efficacy of the single-disease MDT strategy in practice in patients with ovarian malignancies.Methods The medical records of a consecutive patient cohort who underwent single-disease MDT consultation for ovarian malignancies in Sun Yat-sen University Cancer Center from June 2017 to June 2019 were retrospectively reviewed.Statistical analysis was conducted by SPSS 2.0 on the clinical data,MDT consultation recommendation contents,implementation status and follow-up results.Results Among the 243 patients enrolled,203 were diagnosed with primary ovarian cancer,including 5(5/203,2.5%)cases of stageⅠ-Ⅱ,85(85/203,41.9%)cases of stageⅢ-Ⅳ,and 113(113/203,55.7%)cases of recurrence.There were 171 cases of epithelial tumor(171/243,84.2%).A total of 265 consultations were conducted for all cases.Chemotherapy was recommended for 236 person-times(236/265,89.1%)and carried out in 203(203/236,86.0%)of them,among which 184(184/203,90.6%)achieved the expected clinical benefits.The difference was statistically significant compared with those who were not treated as recommended(90.6%vs 45.5%,P<0.001).Surgery was recommended for 154 person-times(154/265,58.1%),among whom 145 patients(145/154,94.2%)were operated,and 143 patients(143/145,98.6%)achieved the expected clinical benefits,showing a statistically significant difference compared with those who were not operated(98.6%vs.33.3%,P<0.001).There were 168 patients(168/265,63.4%)who were recommended ti receive other treatments,among which 112 patients(112/168,66.7%)accepted the treatment,and 95 patients(95/112,84.8%)achieved the expected clinical benefits.The difference was statistically significant(84.8%vs.33.9%,P<0.001).Conclusions The single-disease MDT strategy,which plays an important role in many aspects of clinical practice such as disease assessment,treatment plan layout and overall management,can significantly improves the short-term outcome of patients with ovarian cancer.However,due to the limited follow-up time and case load in this study,the impact on the long-term outcome needs to be further explored.