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北京协和医院脑转移瘤多学科协作诊疗经验:159例病例总结

石易鑫,  王月坤,  邢昊,  陈雯琳,  刘德临,  赵炳昊,  阳天睿,  牛佩,  王裕,  马文斌

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石易鑫, 王月坤, 邢昊, 陈雯琳, 刘德临, 赵炳昊, 阳天睿, 牛佩, 王裕, 马文斌. 北京协和医院脑转移瘤多学科协作诊疗经验:159例病例总结[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0268
引用本文: 石易鑫, 王月坤, 邢昊, 陈雯琳, 刘德临, 赵炳昊, 阳天睿, 牛佩, 王裕, 马文斌. 北京协和医院脑转移瘤多学科协作诊疗经验:159例病例总结[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2022-0268
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SHI Yixin, WANG Yuekun, XING Hao, CHEN Wenlin, LIU Delin, ZHAO Binghao, YANG Tianrui, NIU Pei, WANG Yu, MA Wenbin. Diagnosis and Treatment Experience of Multidisciplinary Team for Brain Metastasis in Peking Union Medical College Hospital: A Summary of 159 Cases[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0268
Citation: SHI Yixin, WANG Yuekun, XING Hao, CHEN Wenlin, LIU Delin, ZHAO Binghao, YANG Tianrui, NIU Pei, WANG Yu, MA Wenbin. Diagnosis and Treatment Experience of Multidisciplinary Team for Brain Metastasis in Peking Union Medical College Hospital: A Summary of 159 Cases[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2022-0268
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北京协和医院脑转移瘤多学科协作诊疗经验:159例病例总结

doi: 10.12290/xhyxzz.2022-0268

  • 中国医学科学院北京协和医院神经外科, 北京 100730

基金项目: 

北京市自然科学基金[19JCZDJC64200(Z),7202150]

清华大学-北京协和医院合作课题(2019ZLH101)

国家自然科学基金(82151302)

详细信息
    通讯作者:

    王裕,E-mail:ywang@pumch.cn

    马文斌,E-mail:mawb2001@hotmail.com

  • 中图分类号: R739.41

Diagnosis and Treatment Experience of Multidisciplinary Team for Brain Metastasis in Peking Union Medical College Hospital: A Summary of 159 Cases

  • Departments of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences&Peking Union Medical College, Beijing 100730, China

Funds: 

Beijing Municipal Natural Science Foundation[19JCZDJC64200 (Z), 7202150]

Tsinghua University-Peking Union Medical College Hospital Initiative Scientific Research Program (2019ZLH101)

National Natural Science Foundation of China (82151302)

    摘要
  • 摘要: 目的 脑转移瘤患者预后差且缺乏统一的诊疗规范,对多学科协作(multidisciplinary team,MDT)诊疗需求极高。通过总结北京协和医院脑转移瘤MDT诊疗经验,以期为临床提供参考。 方法 回顾性纳入2019年1月-2021年12月北京协和医院神经肿瘤中心所有行脑转移瘤MDT诊疗的患者。对其入组时临床特征、诊疗决策、治疗依从性、临床预后等进行归纳、总结,并分析脑转移瘤患者预后的影响因素。 结果 共纳入行脑转移瘤MDT诊疗的患者159例(非脑转移瘤患者13例)。肿瘤来源最多见于肺癌(61.6%),其次为乳腺癌(11.3%)。绝大部分患者(87.4%)仅接受1次MDT诊疗。行初次脑转移瘤MDT诊疗时,患者的主要特征为首要诊断为脑转移瘤(90.6%)、一般状况较好(Karnofsky功能状态评分≥ 70分,79.2%)、年龄≤ 65岁(78.6%)、有原发部位或颅内转移灶病理结果(67.9%)、肿瘤来源为肺癌(61.6%)、颅内单发病灶(54.1%)。76.7%(122/159)的患者经MDT诊疗达成了具体的治疗建议,9.4%(15/159)的患者诊断结果发生改变,随访1年时完全遵从MDT诊疗建议的患者占比56.6%(90/159)。146例脑转移瘤患者6个月生存率为85.6%(125/146),1年生存率为78.8%(115/146)。Kaplan-Meier生存曲线显示,递归分隔分析分级与分级预后评估评分对脑转移瘤患者预后分层有指导意义。多因素Cox回归分析结果显示,女性(HR=0.437,95% CI:0.231~0.828)、完全遵从MDT诊疗建议(HR=0.498,95% CI:0.264~0.942)的脑转移瘤患者通常可获得较好的预后。 结论 应设置合理的脑转移瘤患者入组条件,以提高MDT诊疗效率。多数患者经MDT诊疗后可达成具体的治疗建议,患者治疗依从性良好。MDT诊疗可能有助于患者总体生存率的提高,但确切获益情况需进行个体化评估。
    Abstract: Objective The prognosis of patients with brain metastases is poor and lacking in unified diagnosis and treatment standards. The demand for multidisciplinary team (MDT) diagnosis and treatment mode is extremely high. This study retrospectively summarizes the data of patients treated with MDT for brain metastases in order to provide clinical reference. Methods All patients undergoing MDT treatment for brain metastases at the Neurological Tumor Center of Peking Union Medical College Hospital from January 2019 to December 2021 were retrospectively included. The clinical characteristics, diagnosis and treatment decisions, treatment compliance, clinical prognosis, etc. at the time of enrollment were summarized, and the influencing factors of patients' prognosis were analyzed. Results A total of 159 patients who underwent MDT for brain metastases were included (13 cases with non-cerebral metastases). The most common source of tumor was lung cancer (61.6%), followed by breast cancer (11.3%). The vast majority of patients (87.4%) received only 1 MDT visit. The main characteristics of patients at the time of the initial MDT consultation for brain metastases were primary diagnosis of brain metastases (90.6%), good general condition (Karnofsky functional status score ≥ 70, 79.2%), age ≤ 65 years (78.6%), pathological findings of primary site or intracranial metastases (67.9%), tumor origin of lung cancer (61.6%), and single intracranial lesion (54.1%).76.7% (122/159) of the patients reaching specific treatment recommendations after MDT diagnosis and treatment, 9.4% (15/159) of the patients having changes in diagnosis, and 56.6% (90/159) of the patients exercising full compliance with MDT diagnosis and treatment recommendations at the time of 1-year follow-up. The 6-month survival rate of the 146 patients with brain metastases was 85.6% (125/146) and the 1-year survival rate was 78.8% (115/146). Kaplan-Meier survival curve showed that recursive partition analysis grading and grading prognosis evaluation score had guiding significance for prognosis stratification of patients with brain metastases. Multivariate Cox regression analysis showed that women (HR=0.437, 95% CI:0.231-0.828) and patients with brain metastases who fully complied with MDT diagnosis and treatment recommendations (HR=0.498, 95% CI:0.264-0.942) generally had a better prognosis. Conclusions It is necessary to set reasonable conditions for patients with brain metastases to be enrolled in order to improve the diagnosis and treatment efficiency of MDT. Most patients with brain metastases reached specific treatment recommendations after MDT diagnosis and treatment, and the patients had good treatment compliance. The diagnosis and treatment of MDT may help improve the overall survival rate of patients, but the exact benefits need to be evaluated individually.
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    • 参考文献(28)
  • [1] Fernando C, Frizelle F, Wakeman C, et al. Colorectal multidisciplinary meeting audit to determine patient benefit[J]. ANZ J Surg, 2017, 87:E173-E177.
    [2] Dermine S, Barret M, Prieux C, et al. Impact of a dedicated multidisciplinary meeting on the management of superficial cancers of the digestive tract[J]. Endosc Int Open, 2018, 6:E1470-E1476.
    [3] El Gammal MM, Lim M, Uppal R, et al. Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting[J]. Breast Cancer, 2017, 9:293-296.
    [4] Rao K, Manya K, Azad A, et al. Uro-oncology multidisciplinary meetings at an Australian tertiary referral centre——impact on clinical decision-making and implications for patient inclusion[J]. BJU Int, 2014, 114:50-54.
    [5] Coory M, Gkolia P, Yang I A, et al. Systematic review of multidisciplinary teams in the management of lung cancer[J]. Lung cancer, 2008, 60:14-21.
    [6] Denton E, Conron M, Improving outcomes in lung cancer:the value of the multidisciplinary health care team[J]. J Multidiscip Healthc, 2016, 9:137-144.
    [7] Noyes K, Monson JRT, Rizvi I, et al. Regional Multiteam Systems in Cancer Care Delivery[J]. J Oncol Pract, 2016, 12:1059-1066.
    [8] Basta YL, Bolle S, Fockens P, et al. The Value of Multidisciplinary Team Meetings for Patients with Gastrointestinal Malignancies:A Systematic Review[J]. Ann Surg Oncol, 2017, 24:2669-2678.
    [9] Newman EA, Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board[J]. Cancer, 2006, 107:2346-2351.
    [10] Davies AR, Deans DAC, Penman I, et al. The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer[J]. Dis Esophagus, 2006, 19:496-503.
    [11] Turkaj A, Morelli AM, Vavala T, et al. Management of Leptomeningeal Metastases in Non-oncogene Addicted Nonsmall Cell Lung Cancer[J]. Front Oncol, 2018, 8:278.
    [12] Siam L, Bleckmann A, Chaung HN, et al. The metastatic infiltration at the metastasis/brain parenchyma-interface is very heterogeneous and has a significant impact on survival in a prospective study[J]. Oncotarget, 2015, 6:29254-29267.
    [13] Suh JH, Kotecha R, Chao ST, et al. Current approaches to the management of brain metastases[J]. Nat Rev Clin Oncol, 2020, 17:279-299.
    [14] Salzberg M, Kirson E, Palti Y, et al. A pilot study with very low-intensity, intermediate-frequency electric fields in patients with locally advanced and/or metastatic solid tumors[J]. Onkologie, 2008, 31:362-365.
    [15] Jenkinson MD, Haylock B, Shenoy A, et al. Management of cerebral metastasis:evidence-based approach for surgery, stereotactic radiosurgery and radiotherapy[J]. Eur J Cancer, 2011, 47:649-655.
    [16] Loh D, Hogg F, Edwards P, et al. Two-year experience of multi-disciplinary team (MDT) outcomes for brain metastases in a tertiary neuro-oncology centre[J]. Br J Neurosurg, 2018, 32:53-60.
    [17] Agboola O, Benoit B, Cross P, et al. Prognostic factors derived fr om recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases[J]. Int J Radiat Oncol Biol Phys, 1998, 42:155-159.
    [18] Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment:an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases[J]. J Clin Oncol, 2012, 30:419-425.
    [19] Lamb BW, Sevdalis N, Taylor C, et al. Multidisciplinary team working across different tumour types:analysis of a national survey[J]. Ann Oncol, 2012, 23:1293-1300.
    [20] Lamb BW, Jalil RT, Sevdalis N, et al. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care:a survey study[J]. BMC Health Serv Res, 2014, 14:377.
    [21] Stalfors J, Lundberg C, Westin T. Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer[J]. Acta Otolaryngol, 2007, 127:82-87.
    [22] Bailey M, Qureshi A, Kamaly-Asl I. The role of CT body scans in the investigation of patients with newly diagnosed brain tumours[J]. Br J Neurosurg, 2014, 28:347-350.
    [23] Palmer JD, Trifiletti DM, Gondi V, et al. Multidisciplinary patient-centered management of brain metastases and future directions[J]. Neurooncol Adv, 2020, 2:vdaa034.
    [24] Devitt B, Philip J, McLachlan SA. Team dynamics, decision making, and attitudes toward multidisciplinary cancer meetings:health professionals' perspectives[J]. J Oncol Pract, 2010, 6:e17-e20.
    [25] Team NCA. The Characteristics of an Effective Multidisciplinary team (MDT)[M]. London:National Cancer Action Team, 2010.
    [26] Phang I, Leach J, Leggate JRS, et al. Minimally Invasive Resection of Brain Metastases[J]. World Neurosurg, 2019, 130:e362-e367.
    [27] Kotecha RR, Flippot R, Nortman T, et al. Prognosis of Incidental Brain Metastases in Patients With Advanced Renal Cell Carcinoma[J]. J Natl Compr Canc Netw, 2021, 19:432-438.
    [28] 刘芃昊, 王月坤, 连欣, 等. 一例肾细胞癌脑转移患者的5次MDT:"量体裁衣" 的个体化诊疗模式[J]. 协和医学杂志, 2021, 12:575-583.
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出版历程
  • 收稿日期:  2022-05-10
  • 网络出版日期:  2023-03-15

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