{"title":"Multidisciplinary team quality improves the survival outcomes of locally advanced rectal cancer patients: A post hoc analysis of the STELLAR trial","authors":"","doi":"10.1016/j.radonc.2024.110524","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>We sought to determine the association between multidisciplinary team (MDT) quality and survival of patients with locally advanced rectal cancer.</p></div><div><h3>Methods</h3><p>In a post hoc analysis of the randomized phase III STELLAR trial, 464 patients with distal or middle-third, clinical tumor category cT3-4 and/or regional lymph node-positive rectal cancer who completed surgery were evaluated. Disease-free survival (DFS) and Overall survival (OS) were stratified by Multidisciplinary team (MDT) quality, which was also included in the univariable and multivariable analyses of DFS and OS.</p></div><div><h3>Results</h3><p>According to the univariable analyses, a significantly worse DFS was associated with a fewer specialized medical disciplines participating in MDT (<5 vs ≥ 5; <em>P</em>=0.049),a lower frequency of MDT meetings (<once a week vs ≥ once a week; <em>P</em>=0.021) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; <em>P</em>=0.039). In addition, a lower number of specialized medical disciplines participating in MDT (<5 vs ≥ 5; <em>P</em><0.001), a lower frequency of MDT meetings (<once a week vs ≥ once a week; <em>P</em><0.001) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; <em>P</em>=0.001) were the variables associated with OS. These 3 factors were considered when assessing MDT quality, which was classified into 2 categories: high quality or general quality. Patients treated in hospitals with high MDT quality had longer 3-year OS (90.5 % vs 78.1 %; <em>P</em>=0.001) and similar 3-year DFS (70.3 % vs 61.3 %; <em>P</em>=0.109) compared to those treated in hospitals of the general MDT quality group. Furthermore, multivariable analys<strong>e</strong>s revealed a significance for DFS (HR, 1.648; 95 % CI, 1.143–2.375; <em>P</em>=0.007) and OS (HR, 2.771; 95 % CI, 1.575–4.877; <em>P</em><0.001) in MDT quality.</p></div><div><h3>Conclusions</h3><p>The use of hospitals with optimized multidisciplinary infrastructure had a significant influence on survival of patients with locally advanced rectal cancer.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024035023/pdfft?md5=3bbecd73ece600c6eaef87da35c7960c&pid=1-s2.0-S0167814024035023-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167814024035023","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose
We sought to determine the association between multidisciplinary team (MDT) quality and survival of patients with locally advanced rectal cancer.
Methods
In a post hoc analysis of the randomized phase III STELLAR trial, 464 patients with distal or middle-third, clinical tumor category cT3-4 and/or regional lymph node-positive rectal cancer who completed surgery were evaluated. Disease-free survival (DFS) and Overall survival (OS) were stratified by Multidisciplinary team (MDT) quality, which was also included in the univariable and multivariable analyses of DFS and OS.
Results
According to the univariable analyses, a significantly worse DFS was associated with a fewer specialized medical disciplines participating in MDT (<5 vs ≥ 5; P=0.049),a lower frequency of MDT meetings (<once a week vs ≥ once a week; P=0.021) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; P=0.039). In addition, a lower number of specialized medical disciplines participating in MDT (<5 vs ≥ 5; P<0.001), a lower frequency of MDT meetings (<once a week vs ≥ once a week; P<0.001) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; P=0.001) were the variables associated with OS. These 3 factors were considered when assessing MDT quality, which was classified into 2 categories: high quality or general quality. Patients treated in hospitals with high MDT quality had longer 3-year OS (90.5 % vs 78.1 %; P=0.001) and similar 3-year DFS (70.3 % vs 61.3 %; P=0.109) compared to those treated in hospitals of the general MDT quality group. Furthermore, multivariable analyses revealed a significance for DFS (HR, 1.648; 95 % CI, 1.143–2.375; P=0.007) and OS (HR, 2.771; 95 % CI, 1.575–4.877; P<0.001) in MDT quality.
Conclusions
The use of hospitals with optimized multidisciplinary infrastructure had a significant influence on survival of patients with locally advanced rectal cancer.
目的:我们试图确定多学科团队(MDT)质量与局部晚期直肠癌患者生存率之间的关系:在随机III期STELLAR试验的一项事后分析中,对464名完成手术的远端或中段、临床肿瘤分类为cT3-4和/或区域淋巴结阳性的直肠癌患者进行了评估。无病生存期(DFS)和总生存期(OS)根据多学科团队(MDT)质量进行分层,多学科团队质量也被纳入无病生存期和总生存期的单变量和多变量分析中:根据单变量分析,DFS明显较差与参与MDT的专业医疗学科较少有关(200;P=0.039)。此外,参与 MDT 的专业医疗学科较少(200 个;P=0.001)也是与 OS 相关的变量。在评估MDT质量时考虑了这3个因素,MDT质量分为两类:高质量和一般质量。与在一般MDT质量组医院接受治疗的患者相比,在高质量MDT医院接受治疗的患者的3年OS更长(90.5% vs 78.1%;P=0.001),3年DFS相似(70.3% vs 61.3%;P=0.109)。此外,多变量分析显示,DFS(HR,1.648;95 % CI,1.143-2.375;P=0.007)和OS(HR,2.771;95 % CI,1.575-4.877;PC结论:使用具有优化多学科基础设施的医院对局部晚期直肠癌患者的生存率有显著影响。
期刊介绍:
Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.