多学科诊疗模式对乳腺癌术后辅助化疗决策的影响及相关因素分析  

The influence of multidisciplinary team on adjuvant chemotherapy for postoperative breast cancer patients

作　　者：孟利伟 楼亦猗 章蔚[1] 黄黎明[1] Meng Liwei;Lou Yiqi;Zhang Wei;Huang Liming(Department of Breast and Thyroid Surgery, Shaoxing People’s Hospital, Shaoxing 312000, China)

机构地区：[1]绍兴市人民医院乳腺甲状腺外科,312000

出　　处：《中华内分泌外科杂志》2019年第5期408-412,共5页Chinese Journal of Endocrine Surgery

基　　金：绍兴市科技局科技计划基金(2017B7033).

摘　　要：目的探讨多学科诊疗(multidisciplinary team,MDT)模式对乳腺癌术后辅助化疗决策的影响及相关因素分析。方法回顾性分析2016年5月至2018年5月在绍兴市人民医院乳腺外科接受手术、并经MDT讨论制订术后辅助治疗方案的浸润性乳腺癌患者的临床病理指标和MDT讨论结果。化疗决策改变定义为主诊医师和MDT团队在化疗与否或化疗方案的意见不一致。结果385例患者中,84.9%(327/385)推荐予以化疗。主诊医师与MDT团队的推荐意见不一致导致化疗决策改变有6%(23/385),其中65.2%(15/23)升阶了治疗,34.8%(8/23)降阶了治疗。影响化疗决策改变的相关病理指标包括Ki67表达指数处于15%~30%的中间状态、ER/PR低表达和T1a的小肿瘤。结论MDT模式可影响乳腺癌术后辅助化疗的决策,可在各级基层医院大力推广。Objective To investigate the influence of multidisciplinary team (MDT) model on decision-making of adjuvant chemotherapy for breast cancer and analyze relevant influencing factors. Methods The patients with invasive breast cancer who underwent surgery and MDT discussion for adjuvant treatment in Shaoxing People’s Hospital, from May 2016 to May 2018, were retrospectively analyzed. The patient’s clinicopathological characteristics and postoperative adjuvant treatment and MDT records were obtained. Here the chemotherapy decision alternation was defined as disagreement in chemotherapy or not, or inconsistence in regiments between the attending doctor and multidisciplinary team. Results A total of 385 patients were enrolled in the multidisciplinary discussion and 327 patients (327/385, 84.9%) were suggested to receive chemotherapy. Differences between attending doctor’s recommendation and MDT panel’s decision were found in 23 (23/385, 6%) patients, of whom 15 patients (15/23, 65.2%) were escalated adjuvant treatment and 8 patients (8/23, 34.8%) were de-escalated adjuvant treatment. The relevant pathological indicators affecting the change of chemotherapy decision-making included the Ki67 expression index in the intermediate state of 15% to 30%, the low expression of ER/PR and the small tumor of T1a. Conclusion MDT can influence the decision of adjuvant chemotherapy for breast cancer surgery, and can be promoted in grassroots hospitals at all levels.

关 键 词：多学科诊疗 乳腺癌 化疗 

分 类 号：R737[医药卫生—肿瘤]