乳腺癌多学科诊疗标准与规范(2023年版)

Standardization of multi disciplinary team treatment for breast cancer(2023 edition)

2020年乳腺癌已成为全球发病率最高的恶性肿瘤,近年来随着诊疗技术的提升,中国乳腺癌患者生存率虽显著提高,但仍与西方国家存在较大差异。目前国内乳腺癌诊治仍存在诸多不足的地方,如院内缺少综合治疗的复合型医学人才、患者有效就诊时间短、就诊流程繁琐等。多学科团队诊疗(multidisciplinary team treatment,MDT)模式是由多个学科的资深专家团队合作,针对某一种或某一系统疾病的病例进行讨论,在综合各学科意见的基础上为患者制订出最佳治疗方案的诊疗模式。MDT已经逐渐被多个肿瘤治疗领域接受并广泛实施,很多常见肿瘤治愈率的提高是通过MDT实现的。该模式涉及方面广泛,包括医院制度化建设及核心科室和协同科室的专业合作等。其实施可以提高疾病的诊断率,减少误诊或漏诊,也可以提高指南实施规范性,从而在整体上提高以患者为中心的全病程管理能力及乳腺癌单病种科室的诊疗能力,最终助力《健康中国行动(2019—2030年)》实现。但全国各地MDT实施缺乏统一的流程及标准,国内外尚无专门针对乳腺癌单病种的MDT标准与规范,以指导并提升临床实践能力。本标准与规范由健康报社主办,中国抗癌协会乳腺癌专业委员会发起,在具有肿瘤诊疗相关专科的综合医院和肿瘤专科医院组织多学科专家,依据高级别循证医学依据,通过共同讨论形成赋能专科建设项目并制订《乳腺癌多学科诊疗标准与规范(2023年版)》。本标准与规范的具体内容包括:①乳腺癌MDT组织建设及运营机制的基本要求;②初诊(早期)乳腺癌患者MDT标准与规范;③复诊(复发转移性/初诊晚期)乳腺癌患者MDT标准与规范;④以患者为中心的MDT规范化标准诊疗流程;⑤乳腺癌MDT高质量发展的其他要求及建议。本标准与规范旨在从MDT所有参与的单学科或科室应该承担的职责出发,以患者为中心,提供一站式医疗服务,共同探索符合中国国情的MDT标准与规范,同时评选出优秀及标杆医院,以促进该领域的MDT进展,并进一步规范乳腺癌慢病化与规范化全程管理,最终推动乳腺癌领域的变革与进步,造福乳腺癌患者。

Breast cancer has become the most common malignant tumor in the world since 2020.With the diagnosis and therapeutic regimens improvement in breast cancer,survival rate of Chinese patients has been significantly enhanced in recent years.However,there is still significant difference in overall survival rate between China and western countries.Many unmet needs exist in daily clinical diagnosis and treatment of breast cancer in China e.g.,shortage of high-quality versatile medical talents,insufficient effectively visiting duration for single patient,overly complicated outpatient or inpatient hospital process.Multidisciplinary team treatment(MDT)is an optimized therapeutic model or platform in which many senior medical experts from multiple disciplines would collaborate together to discuss each single case or each category of cases deeply and thoroughly,and then design the specific treatment plans based on all comprehensive recommendations.MDT has been gradually accepted and widely adopted in multiple anti-cancer therapy,and has somehow largely enhanced the cancer cure rate.The MDT model involves many aspects including hospital system construction,cooperation between core and collaborative departments.MDT can improve disease diagnosis rate,reduce misdiagnosis or missed diagnosis,enhance standardization of clinical guidelines,optimize patient-centered whole disease process management and finally strengthen the therapeutic capabilities for breast cancer as a single disease department,ultimately contributing to the achievement of the goal of'Healthy China Initiative(2019-2030)'project.However,current reality is the lack of unified standard for MDT execution process in China,and there is no specific MDT guideline for breast cancer globally and domestically which can guide or enhance the daily clinical practice.Hosted by Chinese Health Newspaper and initiated by Breast Cancer Professional Committee of Chinese Anti-Cancer Association,this paper came from joint discussions of multidisciplinary experts from top general and specialized hospitals based on high-level evidence-based medicine.The main contents were as following:①Basic requirement for hospital or department system construction or operating process for breast cancer MDT;②Standard and requirement for early-stage breast cancer MDT;③Standard and requirement for late-stage breast cancer MDT;④Standard and requirement for patient-centered breast cancer MDT;⑤Other or further requirements for high-quality breast cancer MDT.Here we discussed the exact responsibility of each department involved in MDT,providing patient-centered and one-stop medical services,and then combined together to explore MDT execution standard which would be suitable for current medical care status in China.Meanwhile we selected the outstanding or benchmark hospitals to push forward MDT model enlargement and enhance whole management process of breast cancer as a chronic disease,ultimately to enhance therapeutic improvement in breast cancer and benefit breast cancer patients.