■乳腺癌(BC)管理中的多学科团队会议(MDM)方法是一种护理标准。MDMs的作用之一是为具有早期BC新诊断的患者(pts)确定最佳诊断和治疗策略。这项研究的目的是确定计划计划之间是否有协议(即,基于MDM的决策)和实际应用。此外,这项研究探讨了与不一致相关的因素。
■我们连续对291例新诊断为早期BC的患者进行了回顾性研究,在乌迪内大学医院(意大利)的MDM上讨论,从2017年1月到2018年6月。通过单因素和多因素逻辑回归分析,探讨了临床生物学因素与MDM期间决定的与肿瘤学家因此应用的不一致之间的关联。
■中位年龄为62岁(范围27-88岁)。在侵入性早期BC患者中,最常见的表型是腔A(38%),其次是管腔B(33%),HER2阳性(12%),和三阴性(5%)。原位癌(DCIS)占12%的病例。从MDM讨论到首次肿瘤学检查的中位时间为2周。基于MDM的决策和最终选择之间的不一致率,在与肿瘤科医生面对面的咨询中,为15.8%(46/291)。更改基于MDM的程序的最常见原因是临床决策(87%)。在15%的病例中,在MDM中建议的化疗(CT)优先进行随访,39%的病例采用内分泌治疗(ET)(其中,44.5%诊断为DCIS)。16/46pts(35%)选择了从序贯CT-ET到仅ET的治疗改变:在这些患者中,7人患有管腔B型疾病,6人患有HER2阳性疾病.在单变量分析中,与不一致相关的因素是Ki-6714%-30%(OR3.91;95%CI1.19-12.9),年龄>70岁(OR2.44,95%CI1.28-4.63),家庭主妇/退休身份(OR2.35,95%CI1.14-4.85),复方药(OR1.95;95%CI1.02-3.72),绝经后状态(OR4.15;95%CI1.58-10.9),和高Charlson合并症指数(OR1.31;95%CI1.09-1.57)。与婚姻状况的联系,教育水平,酒精和吸烟习惯,照顾者的存在,奇偶校验,分级,组织型和表型,分期无统计学意义。在多变量分析中,只有Ki-67值保持其统计学意义。
■我们的研究结果可能有助于增强MDM在早期BC临床决策过程中的作用。
UNASSIGNED: A multidisciplinary team meeting (MDM) approach in breast cancer (BC) management is a standard of care. One of the roles of MDMs is to identify the best diagnostic and therapeutic strategies for patients (pts) with new diagnosis of early BC. The purpose of this study was to define whether there was an agreement between the planned program (i.e., MDMs-based decision) and that actually applied. In addition, the study explored factors associated with discordance.
UNASSIGNED: We conducted a retrospective study of a consecutive series of 291 patients with new diagnosis of early BC, discussed at MDMs at the University Hospital of Udine (Italy), from January 2017 to June 2018. The association between clinico-biological factors and discordance between what was decided during the MDMs and what was consequently applied by the oncologist was explored through uni- and multivariate logistic regression analyses.
UNASSIGNED: The median age was 62 years (range 27-88 years). Among invasive early BC patients, the most frequent phenotype was luminal A (38%), followed by luminal B (33%), HER2-positive (12%), and triple-negative (5%). In situ carcinoma (DCIS) represented 12% of cases. The median time from MDM discussion to first oncologic examination was 2 weeks. The rate of discordance between MDM-based decision and final choice, during a face-to-face consultation with the oncologist, was 15.8% (46/291). The most frequent reason for changing the MDM-based program was clinical decision (87%). Follow-up was preferred to the chemotherapy (CT) proposed within the MDMs in 15% of cases, and to the endocrine therapy (ET) in 39% of cases (among these, 44.5% had a diagnosis of DCIS). Therapeutic change from sequential CT-ET to ET alone was chosen in 16/46 pts (35%): among these patients, seven had a luminal B disease and six had an HER2-positive disease. On univariate analysis, factors associated with discordance were values of Ki-67 14%-30% (OR 3.91; 95% CI 1.19-12.9), age >70 years (OR 2.44, 95% CI 1.28-4.63), housewife/retired status (OR 2.35, 95% CI 1.14-4.85), polypharmacy (OR 1.95; 95% CI 1.02-3.72), postmenopausal status (OR 4.15; 95% CI 1.58-10.9), and high Charlson Comorbidity Index (OR 1.31; 95% CI 1.09-1.57). The association with marital status, educational level, alcohol and smoke habits, presence of a caregiver, parity, grading, histotype and phenotype, and stage was not statistically significant. On multivariate analysis, only Ki-67 value maintained its statistical significance.
UNASSIGNED: The results of our study could be useful for enhancing the role of MDMs in the clinical decision-making process in early BC.