Abstract：
BACKGROUND: Management of stage-III-N2 non-small-cell lung cancer (NSCLC) based on a multimodal strategy (surgery or radiotherapycombined with systemic drugs) remains controversial. Patients are treated with a curative intent, and available data suggestprolonged survival after complete resection. However, no consensual definition of \"tumor resectability\" exists. This study aimed to analyze the concordanceamong French tumor board meeting (TBM)-emittedtherapeutic decisions forstage-III-N2 NSCLC.
METHODS: Six patients with stage-III-N2 NSCLC discussed at Saint-Etienne University Hospital\'sthoracic TBMs were selected, anonymouslyreported, and submitted to the participating TBMs. The primary goal of this multicenter, prospective, observational study was to assess the consistency of TBMpanel decisions for each case. The secondary endpointwas identifying the demographic or technical factors that potentiallyaffected decision-making.
RESULTS: Twenty-seven TBMs from university hospitals, a cancer center, general hospitals, and a private hospitalparticipated in this study. None of their decisions for the six cases were unanimous.The decisions were homogenous for three cases (78%, 85%, and 88% TBMs opted for medical treatment, respectively),andmore ambivalent for the other three (medical versus surgical strategies were favored by 44%/56%, 46%/54%, and 58%/42% TBMs, respectively). Interestingly, decisions regarding chemoradiationand perioperative chemotherapyinthe medical and surgical strategies, respectively, were also discordant. Hospital type, specialist participation in TBMs, and activity volumes were not significantly associated with therapeutic decisions.
CONCLUSIONS: The results of this study highlight substantial disparities amongFrench TBMs regarding therapeutic management of stage-III-N2 NSCLC. The decisions were not associated with local conditions.
METHODS: Six patients with stage-III-N2 NSCLC discussed at Saint-Etienne University Hospital\'sthoracic TBMs were selected, anonymouslyreported, and submitted to the participating TBMs. The primary goal of this multicenter, prospective, observational study was to assess the consistency of TBMpanel decisions for each case. The secondary endpointwas identifying the demographic or technical factors that potentiallyaffected decision-making.
RESULTS: Twenty-seven TBMs from university hospitals, a cancer center, general hospitals, and a private hospitalparticipated in this study. None of their decisions for the six cases were unanimous.The decisions were homogenous for three cases (78%, 85%, and 88% TBMs opted for medical treatment, respectively),andmore ambivalent for the other three (medical versus surgical strategies were favored by 44%/56%, 46%/54%, and 58%/42% TBMs, respectively). Interestingly, decisions regarding chemoradiationand perioperative chemotherapyinthe medical and surgical strategies, respectively, were also discordant. Hospital type, specialist participation in TBMs, and activity volumes were not significantly associated with therapeutic decisions.
CONCLUSIONS: The results of this study highlight substantial disparities amongFrench TBMs regarding therapeutic management of stage-III-N2 NSCLC. The decisions were not associated with local conditions.
摘要：
背景：基于多模式策略（手术或放疗联合全身药物）治疗III-N2期非小细胞肺癌（NSCLC）仍存在争议。患者的治疗目的是治愈，现有数据提示完全切除后生存期延长。然而,不存在“肿瘤可切除性”的共识定义。本研究旨在分析法国肿瘤委员会会议（TBM）对III-N2期非小细胞肺癌的治疗决策之间的一致性。
方法：选择在圣艾蒂安大学医院讨论的6例III-N2期非小细胞肺癌患者，匿名报道,并提交给参与的TBMs。这个多中心的主要目标，prospective,观察性研究旨在评估每例TBMpanel决策的一致性.次要终点是确定可能影响决策的人口统计学或技术因素。
结果：来自大学医院的二十七个TBM，一个癌症中心，综合医院,一家私立医院参与了这项研究。他们对这六个案件的裁决没有一个是一致的。三起案件的决定是一致的(78%，85%,88%的TBM选择了医疗，分别)，对其他三个(44%/56%的人赞成医疗与手术策略，46%/54%，和58%/42%的TBM，分别)。有趣的是,关于化疗和围手术期化疗的医疗和外科策略的决定，分别,也不和谐。医院类型,专家参与TBM，活动量与治疗决策无显著相关.
结论：这项研究的结果突出了法国TBM在III-N2期非小细胞肺癌治疗管理方面的巨大差异。这些决定与当地条件无关。
方法：选择在圣艾蒂安大学医院讨论的6例III-N2期非小细胞肺癌患者，匿名报道,并提交给参与的TBMs。这个多中心的主要目标，prospective,观察性研究旨在评估每例TBMpanel决策的一致性.次要终点是确定可能影响决策的人口统计学或技术因素。
结果：来自大学医院的二十七个TBM，一个癌症中心，综合医院,一家私立医院参与了这项研究。他们对这六个案件的裁决没有一个是一致的。三起案件的决定是一致的(78%，85%,88%的TBM选择了医疗，分别)，对其他三个(44%/56%的人赞成医疗与手术策略，46%/54%，和58%/42%的TBM，分别)。有趣的是,关于化疗和围手术期化疗的医疗和外科策略的决定，分别,也不和谐。医院类型,专家参与TBM，活动量与治疗决策无显著相关.
结论：这项研究的结果突出了法国TBM在III-N2期非小细胞肺癌治疗管理方面的巨大差异。这些决定与当地条件无关。
