Xiehe Yixue Zazhi (Mar 2023)
Diagnosis and Treatment Experience of Multidisciplinary Team for Brain Metastasis in Peking Union Medical College Hospital: A Summary of 159 Cases
Abstract
Objective The prognosis of patients with brain metastases is poor and lacking in unifieddiagnosis 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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