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早期肺癌多学科会诊综合管理模式的应用探索
杨雯晖
许天齐
张勇
张艳
席杭天
杨庭义
张艰
作者及单位信息
·
DOI： 10.3760/cma.j.cn112147-20211026-00743
Application of multidisciplinary treatment comprehensive management model for early-stage lung cancer
Yang Wenhui
Xu Tianqi
Zhang Yong
Zhang Yan
Xi Hangtian
Yang Tingyi
Zhang Jian
Authors Info & Affiliations
Yang Wenhui
Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi′an 710000, China
Xu Tianqi
Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi′an 710000, China
Zhang Yong
Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi′an 710000, China
Zhang Yan
Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi′an 710000, China
Xi Hangtian
Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi′an 710000, China
Yang Tingyi
Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi′an 710000, China
Zhang Jian
Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi′an 710000, China
·
DOI： 10.3760/cma.j.cn112147-20211026-00743
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摘要

目的探索多学科会诊（MDT）综合管理模式在早期肺癌诊疗中的应用，分析其临床价值以及推广的可行性和意义。

方法回顾性纳入西京医院2018年1月8日至2019年12月31日经MDT后进行手术的470例患者，其中男172例，女298例，年龄23~79（54.46±11.08）岁。分析基本诊疗信息以及术后病理，其中MDT建议手术441例，主观要求手术29例。比较患者一般情况、术前诊断以及病理结果，总结MDT综合管理模式的具体内容及相关技术运用。同时结合当下国内肺癌发病现状探究MDT综合管理模式在早期肺癌诊疗中的应用价值。

结果470例手术患者中，男性以实性结节居多（69/172，40.1%），女性以磨玻璃结节居多（135/298，45.3%），结节分布总体呈现上叶（277/470）多于下叶（161/470）、右肺（276/470）多于左肺（194/470）的趋势。MDT推荐手术的441例患者中98.11%的男性（156/159）和97.87%的女性（276/282）术后病理提示恶性，腺癌为主要病理类型（男146/156例，93.59%；女269/276例，97.46%）。恶性病理结果中以原位癌（男66/156例，42.31%；女130/276例，47.10%）及Ⅰ期肺癌（男79/156例，50.64%；女131/276例，47.46%）居多。推荐手术的患者中1.89%的男性（3/159）和2.13%的女性（6/282）术后病理提示良性，其中以肺结核和真菌感染为主（各性别均为66.67%，男2/3例；女4/6例）。主观手术的29患者术后病理也以结核与真菌感染为主要类型（男9/13例，69.23%；女11/16例，68.75%）。MDT综合管理模式中充分联合运用多种辅助诊断技术，同时结合多学科参与的经验优势，弥补了单科诊断的局限性，总体诊断符合率可达98.09%，一致性强（Kappa>0.81），其阳性预测值（PPV）为97.96%，阴性预测值（NPV）为100%，患者诊疗周期均值为24.28~26.51 d。

结论MDT综合管理模式符合共识要求，其在诊断效能和诊疗周期方面都具有较大的优势，对于早期肺癌的诊治具有较高的推广应用价值，但在早期肺癌的诊疗中应将结核与真菌的感染应作为重要鉴别诊断项目。

早期肺癌;MDT;管理模式;医疗服务;应用探索
ABSTRACT

ObjectiveTo explore the application of multidisciplinary treatment (MDT) and comprehensive management model in the diagnosis and treatment of early-stage lung cancer, and analyze its clinical value and the feasibility and significance of promotion.

MethodsA retrospective study of 470 patients in Xijing Hospital who underwent surgery after MDT from January 8, 2018 to December 31, 2019. There were 172 males and 298 females, aged from 23 to 79 (54.46±11.08) years. Basic diagnosis and treatment information as well as postoperative pathology were analyzed, of which 441 cases were recommended for surgery by MDT and 29 cases were subjectively requested for surgery. The patients′ general condition, preoperative diagnosis and pathological results were compared, and the specific content of the MDT and comprehensive management model were summarized. We also explored the value of MDT integrated management model in early stage lung cancer treatment in the context of the current lung cancer incidence in China.

ResultsAmong 470 surgical patients, the majority of males had solid nodules (69/172,40.1%), and the majority of females had ground glass nodules (135/298,45.3%). The distribution of nodules showed a trend of more upper lobe(277/470)than lower lobe(161/470) and more right lung(276/470) than left lung(194/470). Among the 441 patients recommended for surgery, 98.11% of males (156/159) and 97.87% of females (276/282) showed malignant pathology after surgery. Adenocarcinoma was the main pathological type (93.59% of males, 146/156; 97.46% of females, 269/276). Among the malignant pathological results, carcinoma in situ (42.31% of males, 66/156; 47.10% of females, 130/276) and stage I lung cancer (50.64% of males, 79/156; 47.46% of females, 131/276) were the most common. In all patients, 1.89% of the males (3/159) and 2.13% of the females (6/282) recommended for surgery showed benign postoperative pathology, of which tuberculosis and fungal infection were the main pathological types (66.67% for each gender, males 2/3, females, 4/6). The postoperative pathology of 29 patients who subjectively requested surgery was also tuberculosis and fungal infection as the main pathological types (69.23% of males, 9/13; 68.75% of females, 11/16). The MDT comprehensive management model made full use of a variety of auxiliary diagnostic technologies and combined the experience advantages of multidisciplinary participation to make up for the limitations of single-diagnosis. The overall diagnosis coincidence rate reached 98.09%, with strong consistency (Kappa>0.81). The positive predictive value (PPV) was 97.96%, the negative predictive value (NPV) was 100%, and the average patient diagnosis and treatment cycle was 24.28-26.51 days.

ConclusionsThe MDT comprehensive management model meets the consensus requirements. It has great advantages in diagnostic efficiency and diagnosis and treatment cycle, and has a high promotion and application value for the diagnosis and treatment of early-stage lung cancer. At the same time, tuberculosis and fungal infection should be regarded as an important differential diagnosis item.

Early Lung Cancer;MDT;Management Model;Medical Service;Application Exploration
Zhang Jian, Email: mocdef.3ab6109820819931
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引用本文

杨雯晖,许天齐,张勇,等. 早期肺癌多学科会诊综合管理模式的应用探索[J]. 中华结核和呼吸杂志,2022,45(03)：261-268.

DOI:10.3760/cma.j.cn112147-20211026-00743

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肺癌是我国第一大肿瘤性疾病，无论是患病率还是病死率均位于首位 ［ 1 , 2 ］ ，且治疗费用昂贵，已成为我国乃至全球重大公共卫生问题 ［ 3 ］ 。虽然当下针对晚期肺癌的治疗方式和技术手段日新月异，一定程度上也有效提高了患者标准化5年生存率 ［ 4 ］ ，但是肺癌（尤其是晚期肺癌）给患者家庭乃至全社会带来的负担依然沉重，实现肺癌的早期诊断和早期治疗具有重要的现实意义。
肺癌在早期阶段临床症状不明显，且胸部影像的形态多变，所以在其诊断方面一直都是重难点问题。因此多学科会诊（multi-disciplinary treatment，MDT）被越来越多地运用于早期肺癌的诊疗 ［ 5 ］ 。要实现早期肺癌的精准诊断，需要多个医疗专科共同参与，讨论得出统一的诊断意见以及后续的治疗方案，最终对每一名肺癌患者构建早诊早治的综合管理模式闭合回路，从而真正实现早期肺癌的精准化诊断和治疗 ［ 6 , 7 , 8 ］ 。本研究通过梳理MDT综合管理模式的方法流程，分析MDT综合管理模式在具体临床实践当中的应用效率。
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备注信息
A
张艰，Email： mocdef.3ab6109820819931
B

杨雯晖, 许天齐, 张勇, 等. 早期肺癌多学科会诊综合管理模式的应用探索[J]. 中华结核和呼吸杂志, 2022, 45(3): 261-268. DOI: 10.3760/cma.j.cn112147-20211026-00743.

C
所有作者声明无利益冲突
D
2017年陕西省研发重点计划 (2017ZDXM-SF-044)
2018年西京医院学科助推计划 (XJZT18MDT26)
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