China Oncology ›› 2022, Vol. 32 ›› Issue (8): 747-756.doi: 10.19401/j.cnki.1007-3639.2022.08.010
• Guideline and Consensus • Previous Articles
The Society of Gynecological Cancer of China Anti-Cancer Association, Multidisciplinary Diagnosis and Treatment (MDT) Committee of China Anti-Cancer Association, Multidisciplinary Cancer Diagnosis and Treatment Committee of Chinese Medical Doctor Association
Received:
2022-07-14
Revised:
2022-08-22
Online:
2022-08-30
Published:
2022-09-19
CLC Number:
The Society of Gynecological Cancer of China Anti-Cancer Association, Multidisciplinary Diagnosis and Treatment (MDT) Committee of China Anti-Cancer Association, Multidisciplinary Cancer Diagnosis and Treatment Committee of Chinese Medical Doctor Association. Consensus of Chinese experts on multidisciplinary team of gynecological malignant tumors (2022 edition)[J]. China Oncology, 2022, 32(8): 747-756.
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×××MDT日志 | ||||||||||||
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MDT地点 | MDT时间 | |||||||||||
首席专家 | 主持人 | |||||||||||
单位科室 | 主管医师 | |||||||||||
参与科室 | ||||||||||||
参与专家 | ||||||||||||
患者 基线特征 | 患者姓名: | 住院/门诊号: | MDT次数: | |||||||||
年龄: | 性别: | ECOG评分: | ||||||||||
主诉 | ||||||||||||
现病史 | ||||||||||||
月经及婚育 | ||||||||||||
既往史 | ||||||||||||
个人史 | ||||||||||||
家族史 | ||||||||||||
患者 临床特征 | 血压(mmHg) | 体温(℃) | ||||||||||
心率(次/分) | 呼吸(次/分) | |||||||||||
体格检查 | ||||||||||||
实验室检查 | ||||||||||||
影像学诊断 | ||||||||||||
影像学检查时间(填写检测日期,非报告日期): | ||||||||||||
病理学诊断 | ||||||||||||
病理学检查时间(填写活检的日期,非报告日期): | ||||||||||||
基因突变检测 | ||||||||||||
基因检测时间(填写活检的日期,非报告日期): | ||||||||||||
既往治疗&疗效评估 | ||||||||||||
既往治疗:填写治疗方案开始日期,初始治疗者填写“无” | ||||||||||||
目前诊断(分期): | ||||||||||||
MDT目的/拟讨论问题: | ||||||||||||
MDT专家意见 | ||||||||||||
各科 专家意见 | ||||||||||||
首席专家意见 | ||||||||||||
MDT共识及意见 | ||||||||||||
循证医学证据 | ||||||||||||
参考指南 | ||||||||||||
参照临床试验 | ||||||||||||
参考文献 | ||||||||||||
执行反馈否全部完成 | ||||||||||||
完全执行 | 部分执行 | 未执行 | ||||||||||
随访信息 | ||||||||||||
随访时间 | 是否死亡 | 是 □ 否 □ | ||||||||||
如果是则死亡日期 | 死亡原因 | |||||||||||
肿瘤评价 | □ 好转;□ 复发;□ 转移;□ 进展;□ 稳定 | |||||||||||
复发情况 | 局部 | 目前诊断 | ||||||||||
远处 | ||||||||||||
不良反应 | ≥3级不良反应 | 发生时间 | ||||||||||
1级不良反应 | ||||||||||||
2级不良反应 | ||||||||||||
3级不良反应 | ||||||||||||
复发后治疗方式 | ||||||||||||
外科 | ||||||||||||
内科 | ||||||||||||
放疗 | ||||||||||||
疗效评价指标 | ||||||||||||
DFS: 月 | PFS: 月 | OS: 月 | QOL: | |||||||||
是否纳入临床试验 | ||||||||||||
患者是否满足入排标准: | 否□ | 是□ | ||||||||||
如果“是”请填写入组临床试验注册号 |
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