中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (11): 840-846.doi: 10.19401/j.cnki.1007-3639.2018.11.007

• 论著 • 上一篇    下一篇

肺癌MDT对于Ⅲ期非小细胞肺癌患者的临床决策影响及预后分析

吴 梅,李应龙,单 莉   

  1. 新疆医科大学第三临床医学院肺内科一病区,新疆 乌鲁木齐 830000
  • 出版日期:2018-11-30 发布日期:2018-12-14
  • 通信作者: 单 莉 E-mail: shanlinew@163.com

The analysis of treatment decision and prognosis of stage Ⅲ non-small cell lung cancer in the multidisciplinary team

WU Mei, LI Yinglong, SHAN Li   

  1. Lung Cancer No.1 Ward, the 3rd Affiliated Teaching Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Published:2018-11-30 Online:2018-12-14
  • Contact: SHAN Li E-mail: shanlinew@163.com

摘要: 背景与目的:Ⅲ期非小细胞肺癌(non-small cell lung cancer,NSCLC)是一组预后差异较大的疾病,根据美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)指南,对于Ⅲ期NSCLC的治疗手段应采用以多学科团队(multidisciplinary team,MDT)为中心的综合治疗,同时更加强调个体化治疗的重要性。该研究旨在进一步探讨肺癌MDT对于Ⅲ期NSCLC患者预后的影响。方法:回顾性分析入组新疆医科大学第三临床医学院2012年1月—2015年4月肺癌MDT共594例NSCLC患者,根据是否服从MDT建议治疗分为两个亚组,比较两个亚组之间的临床病理特征并采用Kaplan-Meier法比较其总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)及无病生存期(diseasefree survival,DFS),并绘制生存曲线;另筛选2010—2011年未开展MDT组前的198例Ⅲ期NSCLC患者定义为非MDT组,比较并分析两组间患者临床-病理分期符合度、住院时长及患者满意度等方面。结果:肺癌MDT组中以是否按MDT建议治疗划分的两亚组间中位PFS和OS差异有统计学意义,中位PFS分别为7.0和6.0个月(P<0.05),中位OS分别为28.0和24.0个月(P<0.05)。两亚组间DFS差异无统计学意义(P=0.24)。经COX多因素分析显示,手术与否、是否服从MDT建议、病理学类型及分期是影响患者预后的独立危险因素(P<0.05)。MDT组的临床病理学分期符合度比非MDT组高,分别为74.24%和65.22%(P<0.05)。MDT组的患者平均满意度高于非MDT组,分别为2.68和2.01(P<0.05),但两组住院时长无明显差异。结论:Ⅲ期NSCLC患者的最佳诊疗模式为MDT。

关键词: 多学科, 非小细胞肺癌, 预后

Abstract: Background and purpose: Stage Ⅲ non-small cell lung cancer (NSCLC) represents a heterogeneous group of diseases. According to National Comprehensive Cancer Network (NCCN), multidisciplinary team (MDT) is an optimal treatment for stage Ⅲ NSCLC, and individualized treatment is emphasized as well. The aim of this study was to evaluate the effect of MDT on stage Ⅲ NSCLC. Methods: Five hundred and ninety-four cases with stage Ⅲ NSCLC, defined as MDT group, were enrolled in the 3rd Affiliated Teaching Hospital of Xinjiang Medical University. They were divided into two subgroups by whether following the advice of MDT, and the data were analyzed using Chi-Square test. Kaplan-Meier survival method was used to calculate the overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS), and the survival curves were generated. P value less than 0.05 was considered statistically significant. One hundred and ninety-eight cases with stage Ⅲ NSCLC, defined as non-MDT group, were included from 2010 to 2011 before establishment of MDT. The consistency of clinical and pathological staging, length of stay and satisfaction of patients were compared between the two groups. Results: There were significant differences in median PFS and OS between the two subgroups. The median PFS was 7.0 and 6.0 months (P<0.05), and the median OS was 28.0 and 24.0 months (P<0.05). There was no significant difference in DFS between the subgroups (P=0.24). Univariate and multivariate analyses of the prognostic factors for stage Ⅲ NSCLC showed that surgery or not, whether follow the advice of MDT, histological type and stage were independent risk factors affecting the prognosis (P<0.05). MDT group had a higher degree of consistency of clinical and pathological staging compared with non-MDT group (74.24% vs 65.22% , P<0.05). The median satisfaction of patients of MDT was better than that of non-MDT group (2.68 vs 2.01, P<0.05). The length of stay in hospital between the two groups had no significant difference. Conclusion: MDT is an optimal treatment for stage Ⅲ NSCLC.

Key words: Multidisciplinary team, Non-small cell lung cancer, Prognosis