| Objective: The aim of this study was to examine the impact of the multidisciplinary team(MDT)on the management and prognosis of cervical cancer patients receiving radical concurrent chemoradiotherapy and to explore the current state of development of this model in oncology care.Methods: 1.Data collection: this study retrospectively analyzed patients with cervical cancer treated with radical simultaneous radiotherapy between January 2019 to December 2021 at the Affiliated Hospital of Southwest Medical University.Patients who did not participate in MDT meetings from 2019.01 to 2020.06 were divided into the non-MDT group,and the remaining patients who participated in MDT were divided into the MDT group.The basic information of patients was extracted including age,stage,pathological type,tumour length,degree of differentiation,squamous cell carcinoma antigen(SCCA),presence of lymph node metastasis,bone marrow suppression,gastrointestinal response,rectal response,bladder response,etc.2.MDT profiles were analysed: the impact of MDT on patient consultation and treatment planning was presented as a bar chart;correlation studies were used to analyse the correlation between the collected clinicopathological characteristics and the consistency of pre-and post-MDT recommendations and the consistency of MDT recommendations with clinical outcomes;COX regression was used to analyse the impact of compliance and consistency of MDT recommendations on progression-free survival(PFS)and overall survival(OS).3.Propensity score matching was used to ensure a balance of characteristics between the two groups: propensity score matching(PSM)analysis was performed using a 1:1 match and a caliper of 0.01 for nearest neighbour matching.Propensity scores were estimated by logistic regression using the following covariates: diagnostic stage,age,type of differentiation,type of pathology,tumour size,and lymph node metastasis.Differences in local control of tumour,radiotherapy-related adverse effects(myelosuppression,gastrointestinal reactions,rectal reactions,bladder reactions)between the two groups were compared using a chi-square test.Baseline characteristics of measured data before and after matching were compared using two independent samples t-test,and count data were compared using chi-square test.4.Multidimensional comparison of patients in the MDT and non-MDT groups: differences in local control of tumour,radiotherapy-related adverse effects(bone marrow suppression,gastrointestinal reactions,rectal reactions,bladder reactions)between the two groups were compared using the chi-square test.Differences in PFS and OS between the two groups were compared using K-M survival analysis,and univariate and multifactorial COX regression were used to explore the factors affecting survival.Results: 1.Data overview: A total of 606 cases were collected,253 in the MDT group and 353 in the non-MDT group.During the study period,a total of 563 MDTs were conducted in 253 cervical cancer patients,with 147 participants before treatment,59 participants during treatment and 188 participants during post-treatment follow-up.MDTs were conducted 147 times before treatment,59 times during treatment and 357 times during post-treatment follow-up.2.Type of MDT recommendations: MDT recommendations before and during treatment most often involved the determination of a treatment plan(61.74%),followed by lymph node involvement(31.74%).The most frequent advice given by the MDT during post-treatment follow-up was to continue follow-up(75.91%),followed by further improvement of investigations(11.76%).3.Correlation of each clinicopathological feature collected with MDT recommendations: There was no significant correlation between each clinicopathological feature and MDT recommendations and clinical outcome consistency.Lymph node involvement correlated with consistency of follow-up recommendations before and after MDT,with a statistically significant difference(P=0.044).4.Inconsistency between MDT and clinical was associated with worse prognosis: COX regression showed that inconsistency between MDT recommendations and clinical outcomes(HR=12.677,P<0.001,95% CI3.237-25.767),inconsistency between pre-and post-MDT recommendations was associated with worse PFS(HR=6.471,P=0.002,95% CI 1.942-21.560),and inconsistency between MDT recommendations and clinical outcomes was associated with worse OS(HR=8.047,P=0.003,95% CI 2.007-32.261).5.The MDT group had a better prognosis compared to the non-MDT group: there was no statistically significant difference in local control and progression-free survival(PFS)between the two groups before and after propensity score matching(P>0.05).Before propensity score matching,the MDT group had a better overall survival rate,with an overall survival rate of100% at 1 year and 96.44% at 2 years for all patients in the MDT group,and96.03% at 1 year and 91.50% at 2 years in the non-MDT group,with a statistically significant difference between the two groups(P=0.045),and this difference was particularly significant in stage III and IV patients.In stage III patients,the overall survival rate at 1 year was 100% in the MDT group and 97.16% at 2 years.The non-MDT group had an overall survival rate of 94.55% at 1 year and 86.36% at 2 years.The difference between the two groups was statistically significant(P=0.0068).In stage IV patients,the overall survival rate at 1 year was 100% in the MDT group,82.35% at 2years.The non-MDT group had an overall survival rate of 70.83% at 1 year.54.17% at 2 years.The difference between the two groups was statistically significant(P=0.048);after propensity score matching,the MDT group still had better overall survival,with 100% overall survival at 1 year and 96.27%overall survival at 2 years in the MDT group and 95.28% overall survival at1 year and 89.62% overall survival at 2 years in the non-MDT group among all patients,a statistically significant difference between the two groups(P=0.015),and this difference was also seen in stage III patients,with an overall survival rate of 100% at 1 year and 97.14% at 2 years in the MDT group,and 94.90% at 1 year and 86.73% at 2 years in the non-MDT group,with a statistically significant difference between the two groups(P=0.018).6.MDT was an independent protective factor for overall survival,but had no significant effect on improving radiotherapy-related adverse effects:univariate and multifactorial COX regression showed that FIGO stage IV(HR=6.877,P=0.002,95% CI 2.019-23.419),increasing age(HR=1.062,P=0.001,95% CI 1.024-1.101),and tumour length >4 cm(HR=4.164,P=0.002,95%CI 1.708-10.149)were independent risk factors for overall survival,while participation in MDT(HR=0.406,P=0.031,95%CI0.179-0.921),combined radiotherapy-induced myelosuppression(HR=0.609,P= 0.007,95% CI 0.425-0.873)was an independent protective factor for overall survival.For patients with stage III cervical cancer,increasing age(HR=1.085,P=0.002,95%CI 1.030-1.144)was an independent risk factor for overall survival,while participation in MDT(HR=0.258,P=0.039,95%CI0.071-0.933)was an independent protective factor for overall survival.The differences in radiotherapy-related adverse effects(myelosuppression,gastrointestinal reactions,rectal reactions and bladder reactions)between the two groups of patients were not statistically significant.Conclusion: 1.The MDT model improves overall survival for cervical cancer patients receiving radical concurrent radiotherapy,particularly in stage III patients.This effect may be due to the revised lymph node diagnosis and more individualised radiotherapy planning during MDT discussions.2.Although MDT did not show a benefit at progression-free survival,survival curves suggest that participation in MDT may lead to earlier detection of tumour recurrence.The multidisciplinary model of care has value for clinical replication in cervical cancer. |
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