Abstract：
Multidisciplinary team meetings (MDTs) are recommended for patients with esophageal cancer. Improved staging, timeliness to surgery and better adherence to guidelines have been attributed to MDTs, but there are few studies published on the MDTs\' effect on survival. All patients with esophageal cancer in Sweden between 2006 and 2018 were grouped according to whether they had been discussed at an MDT as part of their clinical pathway. Factors affecting group allocation were explored with multivariable logistic regression, and the impact of MDT on survival was studied with Cox-regression and the Kaplan-Meier estimator. Of 6837 included patients, 1338 patients (20%) were not discussed at an MDT. Advanced age (80-90 years; odds ratio [OR] 0.25, 0.16-0.42 (95% confidence interval)) and clinical stage IVb (OR 0.65, 0.43-0.98) decreased the probability of being presented at an MDT, whereas high education level (OR 1.31, 1.02-1.67), being married (OR 1.20, 1.01-1.43), squamous histology (OR 1.50, 1.22-1.84) and later year of diagnosis (OR 1.33, 1.29-1.37 per year) increased the probability of an MDT. In multivariable adjusted analysis, MDT discussion was associated with improved survival (hazard ratios 0.72, 0.66-0.78) and median survival increased from 4.5 to 10.7 months. MDTs were associated with improved survival for esophageal cancer patients. Elderly patients with advanced disease and poor socioeconomic status were less likely to be presented at an MDT, but had clear survival-benefits if they were discussed in a multidisciplinary setting.
摘要：
建议食管癌患者使用多学科小组会议（MDTs）。改进了分期,手术的及时性和对指南的更好遵守已归因于MDT，但很少有研究发表MDTs对生存的影响。2006年至2018年瑞典的所有食管癌患者都根据是否在MDT中作为其临床路径的一部分进行了讨论进行分组。采用多变量logistic回归分析小组分配的影响因素,用Cox回归和Kaplan-Meier估计方法研究MDT对生存率的影响。在6837名患者中，1338名患者（20％）在MDT中没有讨论。高龄（80-90岁；比值比[OR]0.25，0.16-0.42（95％置信区间））和临床阶段IVb（OR0.65，0.43-0.98）降低了在MDT中出现的可能性，而高等教育水平（OR1.31，1.02-1.67），已婚（OR1.20，1.01-1.43），鳞状组织学(OR1.50,1.22-1.84)和诊断年份(OR1.33,1.29-1.37/年)增加了MDT的可能性.在多变量调整分析中，MDT讨论与生存率改善相关（风险比0.72，0.66-0.78），中位生存期从4.5个月增加到10.7个月。MDTs与食管癌患者生存率改善相关。患有晚期疾病和不良社会经济地位的老年患者不太可能出现在MDT，但如果在多学科环境中进行讨论，则具有明显的生存益处。
