多学科团队诊疗模式对结直肠癌肝转移患者的临床应用价值

发布时间：2018-06-13 21:56

  本文选题：多学科 + 结直肠癌肝转移　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:目前,对伴有肝转移的结直肠癌患者,单纯进行手术、化疗、放疗、分子靶向药物治疗、介入治疗等均有所获益。但单一疗法已经难以获得满意的治疗效果。多学科团队诊疗模式的出现为解决这一问题做出巨大贡献,关于其临床获益,目前尚无明确报道。本研究回顾性搜集大连医科大学附属第一医院肿瘤科首诊时新确诊的CRCLM患者,对其临床资料进行分析。旨在评估MDT诊疗模式对CRCLM患者的临床应用价值。方法:搜集2013年8月至2016年2月期间,大连医科大学附属第一医院肿瘤科收治的,符合以下纳入标准的患者:(1)年龄18岁,性别不限;(2)ECOG评分2;(3)有病理组织学证据,证实为CRC;(4)经影像学证实有肝转移;(6)于肿瘤科门诊或住院部首诊确诊为CRCLM的患者,且既往未进行任何肿瘤相关治疗;(6)既往无肿瘤病史;(7)初诊时无肝外转移;(8)既往无严重心脏病史;对所搜集的患者进行全程追踪随访,随访截至日期至2017年2月。根据患者入院后是否参与MDT会诊,将参与会诊的患者纳入MDT组,未参与会诊的患者纳入非MDT组。应用SPSS 20.0统计软件,对所搜集的数据进行统计学分析。采用卡方检验对比两组一般临床资料,采用配对t检验比较组内治疗前后生活质量差异,应用重复测量方差分析对比两组间生活质量差异,使用Kaplan-Meier法对两组生存情况进行分析。P0.06代表有统计学意义。结果:经过筛选,共搜集符合条件的CRCLM患者114例,MDT组纳入患者63例(n=63),非MDT组纳入患者61例(n=61)。1.一般资料两组患者基线资料,包括年龄、性别、病理类型、原发灶情况(部位、侵犯程度、淋巴结转移)、肝转移情况(部位、数目、大小)均无差异,P0.0g。2.手术切除率两组共有46例患者接受手术治疗,总体手术切除率39.47%;MDT组共有29例患者施行手术治疗,手术切除率为64.72%;非MDT组共有16例患者施行手术治疗,手术切除率为26.23%;两组患者手术切除率存在统计学差异,P0.06。3.生活质量MDT组患者治疗后较治疗前在躯体功能、情绪功能、总体健康状况、恶心/呕吐及疼痛等方面有所改善,P0.06;非MDT组患者治疗后较治疗前仅在躯体功能、总体健康状况、恶心/呕吐及疼痛等方面有所改善,P0.06;MDT组与非MDT组患者在躯体功能、情绪功能、总体健康情况、恶心/呕吐及疼痛上的改善均有显著差异,P0.06。4.生存期随访结束时间为2017年2月。MDT组随访4-41个月,随访结束时27人死亡,无失访病例。中位0S,1,2年生存率分别为26.04±1.44个月,93.66%,66.71%。非MDT随访3-40个月,随访结束时32人死亡,失访1人。中位os,1,2年生存率分别为21.12 ±1.39个月,86.94%,39.34%。两组1年生存率无差异(X2=2.34,P=0.21),MDT组患者的中位0S和2年生存率显著高于非MDT组,差异有统计学意义(OS X2=6.00,P=0.026,2 年生存率 X2=11.26,P=0.001)结论:1.MDT诊疗模式可以提高CRCLM患者的手术切除率。2.MDT诊疗模式可以改善CRCLM患者的生活质量。3.MDT诊疗模式能够延长CRCLM患者的生存期(中位0S,2年生存率),对于长期生存率的影响有待于进一步研究。
[Abstract]:Objective: at present, surgery, chemotherapy, radiotherapy, molecular targeted drug therapy and interventional therapy are beneficial for colorectal cancer patients with liver metastases. However, single therapy has been difficult to achieve satisfactory results. The emergence of multidisciplinary team diagnosis and treatment model has made great contributions to solving the problem. This study reviewed the clinical data of the newly diagnosed CRCLM patients at the First Affiliated Hospital of Dalian Medical University, the first hospital of the First Affiliated Hospital of Dalian Medical University. The purpose of this study was to evaluate the clinical application value of the MDT diagnosis and treatment model to the patients of CRCLM. Methods: from August 2013 to February 2016, the First Affiliated Hospital of Dalian Medical University was collected. Patients admitted to the Department of oncology were in accordance with the following criteria: (1) age 18, sex unlimited; (2) ECOG score 2; (3) histopathological evidence, CRC; (4) liver metastases confirmed by imaging; (6) patients diagnosed with CRCLM in the oncology outpatient or inpatient department, without any previous tumor related treatment; (6) without previous oncology (7) no extrahepatic metastases at first diagnosis; (8) no history of serious heart disease; the whole course was followed up and followed up to February 2017. The patients who participated in the MDT consultation were included in the group MDT, and the patients who were not involved in the consultation were included in the non MDT group. The SPSS 20 statistical software was used to search the patients. The data of the set were statistically analyzed. Two groups of general clinical data were compared with the chi square test. The difference of life quality before and after treatment in the group was compared with the paired t test. The difference of life quality between the two groups was compared with the repeated measurement of variance analysis. The statistical significance of the two groups of survival conditions in the two groups was analyzed by the Kaplan-Meier method. Results: after screening, 114 patients with eligible CRCLM were collected, 63 cases (n=63) were included in group MDT, and the baseline data of two groups of patients with 61 cases (n=61).1. were included in the non MDT group, including age, sex, pathological type, primary lesion (location, invasion range, lymph node metastasis), and liver metastasis (location, number, size), P0 There were 46 cases of.0g.2. resection rate in two groups, the total resection rate was 39.47%, and 29 patients in group MDT were treated with surgical resection rate of 64.72%, and 16 patients in non MDT group were treated with surgical resection rate of 26.23%, and there were statistically significant differences in hand resection rate in the two groups, and P0.06.3. quality of life MD. After treatment, the patients in group T were improved in physical function, emotional function, overall health, nausea / vomiting and pain, P0.06. Patients in non MDT group were improved in physical function, overall health status, nausea / vomiting and pain before treatment, P0.06, MDT and non MDT patients in body function and mood. There were significant differences in function, overall health, nausea / vomiting and pain improvement. The P0.06.4. survival period was followed up for 4-41 months in group.MDT in February 2017. At the end of the follow-up, 27 people died, no missing cases. The median 0S, 1,2 year survival rate was 26.04 + 1.44 months respectively, 93.66%, 66.71%. non MDT follow-up 3-40 months, 3 at the end of follow-up 3. 2 people died and lost 1. Median OS, 1,2 year survival rate was 21.12 + 1.39 months respectively, 86.94%, 39.34%. two group 1 year survival rate no difference (X2=2.34, P=0.21). The median 0S and 2 years survival rate in group MDT was significantly higher than that of non MDT group, the difference was statistically significant (OS X2=6.00, P= 0.026,2 year survival rate) conclusion: To improve the surgical excision rate of CRCLM patients.2.MDT diagnosis and treatment model can improve the quality of life of CRCLM patients,.3.MDT diagnosis and treatment model can prolong the survival period of CRCLM patients (median 0S, 2 year survival rate), and the effect on long-term survival needs to be further studied.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34
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本文编号：2015584