多学科模式下早期乳腺癌化疗决策改变的影响因素分析  

Analysis of multidisciplinary team decision-making modification related factors in early breast cancer adjuvant chemotherapy

作　　者：梁跃[1] 陈小松[1] 吴佳毅[1] 黄欧[1] 宗瑜[1] 毛艳[1] 孙龙[1] 方琼[1] 何建蓉[1] 朱丽[1] 陈伟国[1] 李亚芬[1] 沈坤炜[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院乳腺疾病诊治中心,上海200025

出　　处：《中华肿瘤防治杂志》2015年第22期1769-1773,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：上海市科委技术委员会科技创新行动计划(14411950200;14411950201)

摘　　要：目的随着乳腺癌综合治疗理念的更新,单一学科已不能满足乳腺癌治疗的需要,多学科模式由此建立。本研究分析多学科(multidisciplinary team,MDT)模式下早期乳腺癌化疗决策改变的影响因素。方法收集2013-01-14-2013-12-31上海交通大学医学院附属瑞金医院乳腺疾病诊治中心750例接受手术治疗,并经MDT讨论制定术后辅助治疗方案的浸润性乳腺癌患者的临床病理资料与MDT讨论资料,选取其中410例临床病理资料与MDT讨论记录完整者,分析临床病理指标对MDT讨论前主诊医生化疗建议与MDT化疗决策一致性的影响。结果 410例浸润性乳腺癌患者,MDT决策建议其中301例(73.4%)患者接受化疗。主诊医生与MDT化疗决策一致率为96.1%(394例),16例(3.9%)患者出现化疗决策改变。单因素分析显示,分子分型与化疗决策一致性有相关性,χ2=11.193,P=0.011;对主诊医生与MDT化疗决策不一致病例进行分析发现,luminal A型患者12例出现化疗决策改变。21基因复发风险评分(recurrence score,RS)是影响luminal A型乳腺癌化疗决策改变出现频率最高的因素。结论分子分型是乳腺癌化疗决策一致性的影响因素;RS是luminal A型乳腺癌化疗决策的重要参考依据。OBJECTIVE With the development of comprehensive breast cancer treatment, mono-disciplinary could not satisfy the need of breast cancer treatment, multidisciphnary team was estalished. During the process of decision-making in breast cancer adjuvant chemotherapy,multidisciplinary team （MDT） working may change the initial idea of the at tending doctor. This study focused on identifying factors associated with this change. METHODS The analysis was performed in patients with invasive breast cancer who have obtained adjuvant chemotherapy plan through MDT meeting from 14th Jan 2013 to 31th Dec 2013 in Ruijin Hospital,Shanghai Jiaotong University School of Medicine,adjuvant chemotherapy strategy was made in MDT meetings. RESULTS Among 410 patients,301（73.4%） patients received chemotherapy. Differences between attending doctor＇s recommendation and MDT panel＇s decision were found in 16 （3.9 %） patients. Molecular subtypes （χ^2 = 11.193, P = 0.011 ） were correlated with the concordance rate, cases with decision-making modification were more often seen in luminal A disease,and the most common factor relative to chemotherapy decision-making modification in luminal A disease was 21-gene recurrence score （RS）. CONCLUSIONS Molecular subtype is crucial factor in MDT chemotherapy decision-making modification. As for luminal A breast cancer,RS was an important reference factor in chemotherapy decision-making modification.

关 键 词：多学科模式 早期乳腺癌 化疗决策 分子分型 

分 类 号：R737.9[医药卫生—肿瘤]