多学科综合诊疗对直肠癌临床分期及诊疗策略的影响

Influence of multidisciplinary treatment on clinical staging and diagnosis and treatment strategies for rectal cancer

目的探讨多学科综合诊疗(MDT)对直肠癌临床分期及诊疗策略的影响。方法回顾性病例系列研究。回顾性分析2021年3月至12月山西省人民医院行手术治疗的142例直肠癌患者的临床资料。根据患者是否实施MDT分为MDT组(68例)与非MDT组(74例),比较两组基本资料(性别、年龄等)、TNM分期、是否行新辅助放化疗、术式、R0切除率等,总结患者MDT实施方法和效果。结果两组首诊临床N分期、是否辅助放化疗的患者比例比较,差异均有统计学意义(均P<0.05)。MDT组首诊临床T分期和病理T分期总体符合率为67.6%(46/68),非MDT组的总体符合率为50.0%(37/74),两组比较差异有统计学意义(χ2=4.54,P=0.033);MDT组的首诊临床N分期和病理N分期总体符合率为50.0%(34/68),非MDT组的总体符合率为54.1%(40/74),两组比较差异无统计学意义(χ2=0.23,P=0.629);MDT组新辅助放化疗治疗率为57.4%(39/68),非MDT组为4.1%(3/74),两组差异有统计学意义(χ2=48.33,P<0.001);MDT组与非MDT组R0切除率均为100.0%,上切缘、下切缘和环周切缘均未发现肿瘤组织。结论MDT能为患者提供更加精准的临床分期与有效的诊疗意见,为治疗方案的选择提供可靠指导。

Objective To explore the influence of multidisciplinary treatment(MDT)on clinical staging and diagnosis and treatment strategies for rectal cancer.Methods A retrospective case series study was conducted.The clinical data of 142 rectal cancer patients who underwent surgical treatment in Shanxi Provincial People's Hospital from March 2021 to December 2021 were retrospectively analyzed.According to whether to implement MDT or not,all patients were divided into MDT group(68 cases)and non-MDT group(74 cases).Relevant clinical data including patients'basic information(gender,age,etc.),TNM staging,whether to receive neoadjuvant radiotherapy and chemotherapy or not,surgical methods,R0 resection rate of both groups were compared.The implementation methods and the effects of MDT for patients were summarized.Results There were statistically significant differences in the proportion of clinical N staging at initial diagnosis,whether to receive neoadjuvant radiotherapy and chemotherapy or not of both groups(all P<0.05).The overall agreement rate of clinical T staging at initial diagnosis and pathological T staging was 67.6%(46/68),50.0%(37/74),respectively in the MDT group and the non-MDT group,and the difference was statistically significant(χ2=4.54,P=0.033).The overall agreement rate of N staging at initial diagnosis and pathological N staging was 50.0%(34/68),54.1%(40/74),respectively in the MDT group and the non-MDT group,and the difference was not statistically significant(χ2=0.23,P=0.629).The treatment rate of neoadjuvant radiotherapy and chemotherapy was 57.4%(39/68)and 4.1%(3/74),respectively in the MDT group and the non-MDT group,and the difference was statistically significant(χ2=48.33,P<0.001).The R0 resection rate in both the MDT group and non-MDT group was 100.0%,and no tumor tissue was found at the upper,lower,and circumferential margins.Conclusions MDT could provide more accurate clinical staging and more effective diagnosis and treatment opinions for patients,and provide reliable guidance for the treatment selections.