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Abstract：
BACKGROUND: Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment.
METHODS: Of the 6760 patients diagnosed with rectal cancer in Sweden between 2007 and 2010, 78% were evaluated at a MDT. Factors that influenced whether a patient was discussed at a preoperative MDT conference were evaluated in 4883 patients, and the impact of MDT evaluation on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours.
RESULTS: Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated at hospitals with < 29 procedures per year had an odds ratio (OR) for MDT evaluation of 0.15. Age and tumour stage also influenced the chance of MDT evaluation. MDT evaluation significantly predicted the likelihood of being treated with preoperative radiotherapy in patients with pT3c-pT4 M0 tumours (OR 5.06, 95% CI 3.08-8.34), and pN+ M0 (OR 3.55, 95% CI 2.60-4.85), even when corrected for co-morbidity and age.
CONCLUSIONS: Patients with rectal cancer treated at high-volume hospitals are more likely to be discussed at a MDT conference, and that is an independent predictor of the use of adjuvant radiotherapy. These results indirectly support the introduction into clinical practice of discussing all rectal cancer patients at MDT conferences, not least those being treated at low-volume hospitals.
METHODS: Of the 6760 patients diagnosed with rectal cancer in Sweden between 2007 and 2010, 78% were evaluated at a MDT. Factors that influenced whether a patient was discussed at a preoperative MDT conference were evaluated in 4883 patients, and the impact of MDT evaluation on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours.
RESULTS: Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated at hospitals with < 29 procedures per year had an odds ratio (OR) for MDT evaluation of 0.15. Age and tumour stage also influenced the chance of MDT evaluation. MDT evaluation significantly predicted the likelihood of being treated with preoperative radiotherapy in patients with pT3c-pT4 M0 tumours (OR 5.06, 95% CI 3.08-8.34), and pN+ M0 (OR 3.55, 95% CI 2.60-4.85), even when corrected for co-morbidity and age.
CONCLUSIONS: Patients with rectal cancer treated at high-volume hospitals are more likely to be discussed at a MDT conference, and that is an independent predictor of the use of adjuvant radiotherapy. These results indirectly support the introduction into clinical practice of discussing all rectal cancer patients at MDT conferences, not least those being treated at low-volume hospitals.
摘要：
背景：多学科团队（MDT）会议已被引入标准癌症治疗中，尽管它对患者有益的证据很弱。我们使用瑞典国家直肠癌注册来评估MDT会议上病例讨论的预测因素及其对治疗的影响。
方法：在2007年至2010年间，在瑞典诊断为直肠癌的6760例患者中，有78％的患者进行了MDT评估。在4883例患者中评估了影响患者是否在术前MDT会议上讨论的因素，并对1043例pT3c-pT4M0肿瘤患者进行了MDT评估对术前放疗实施的影响，1991年pN+M0肿瘤患者。
结果：医院数量，即每年进行的直肠癌外科手术的数量，是MDT评估的主要预测因子。在医院接受治疗的患者每年进行<29次手术，MDT评估的比值比（OR）为0.15。年龄和肿瘤分期也影响MDT评估的机会。MDT评估显著预测pT3c-pT4M0肿瘤患者术前放疗的可能性(OR5.06,95%CI3.08-8.34),和pN+M0(OR3.55，95%CI2.60-4.85)，即使纠正了合并症和年龄。
结论：在高容量医院治疗的直肠癌患者更有可能在MDT会议上讨论，这是使用辅助放疗的独立预测因子。这些结果间接支持在MDT会议上讨论所有直肠癌患者的临床实践。尤其是那些在小批量医院接受治疗的人。
方法：在2007年至2010年间，在瑞典诊断为直肠癌的6760例患者中，有78％的患者进行了MDT评估。在4883例患者中评估了影响患者是否在术前MDT会议上讨论的因素，并对1043例pT3c-pT4M0肿瘤患者进行了MDT评估对术前放疗实施的影响，1991年pN+M0肿瘤患者。
结果：医院数量，即每年进行的直肠癌外科手术的数量，是MDT评估的主要预测因子。在医院接受治疗的患者每年进行<29次手术，MDT评估的比值比（OR）为0.15。年龄和肿瘤分期也影响MDT评估的机会。MDT评估显著预测pT3c-pT4M0肿瘤患者术前放疗的可能性(OR5.06,95%CI3.08-8.34),和pN+M0(OR3.55，95%CI2.60-4.85)，即使纠正了合并症和年龄。
结论：在高容量医院治疗的直肠癌患者更有可能在MDT会议上讨论，这是使用辅助放疗的独立预测因子。这些结果间接支持在MDT会议上讨论所有直肠癌患者的临床实践。尤其是那些在小批量医院接受治疗的人。
