Cancer and Reproducibility of Decisions

Cancer and Reproducibility of Decisions Ur ologic ca n cer : W h a t a bo u t re p r odu c ib i l i ty of d ec i s ion m a de a t m ultidi sci plin a r y t e a m m a n a g e m e nt? BAYOUD Y, LOOCK PY, MENARD J, MESSAOUDI R, RIPERT T, PIERREVELCIN J, KOZAL S, LEON P, KAMDOUM M, CHOLET I, LARRE S . Â   Abstract: I nt r odu c t i on : The prostate cancer (PCa) treatment is multimodal. Thus multidisciplinary team management (MDTM) decision-making process appears as a tool to answer all aspects of PCa. To evaluate the reproducibility of therapeutic decisions made at MDTM. M a t erials a n d M e thod s : We compared therapeutic decisions of PCa by presenting the same file of patient under a fake identity after 6 to 12 months from the first presentation. Forty-nine files of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical localized PCa were represented at MDTM which included urologist, oncologist, pathologist and radiologist. Analysis of therapeutic decisions comprised criteria as: TNM stage, Gleason score, margin status and comorbidities. The reproducibility was assessed statistically by Kappa coefficient. R es u l t s: Forty-nine file of radical prostatectomy (RP). The mean age was similar in both groups. The mean PSA was 8,32 ng/ ml (3,56-19,5) in pT2 group and 9.4ng/ml (3,8-22) in pT3 group. The margin status was positive in 25% and 47,6% respectively in pT2 and pT3 group. Decision made for pT2 group were the same in 100% case (k=1). In the group of pT3 (n=21), 33% of decision were different at second MDTM, especially for pT3b with only 29% reproducible decision (k= 0,1). Concerning pT3a, 86% of decision were reproducible (k= 0,74). Con cl u s i on : We showed a reliability and reproducibility of decision made at MDTM when guidelines are well defined. The therapeutic attitudes were less reproducible in locally advanced PCa but decision concerning those cases should be made in the setting of guidelines. K e y w o r d s : Cancer, Kappa coefficient, Prostate , multidisciplinary, Reproducibility. INTRODUCTION: The prostate cancer (PCa) is the most frequent cancer in men as well in Europe and USA (1). The PCa counts for 11% of all men cancers and it’s responsible for 9% of the mortality by cancer in men in Europe. In France in 2010, the incidence of PCa was 71577 cases and the related mortality of PCa at the same year was 8791 deaths which represent a 2.5% less mortality per year during last years (2). The multidisciplinary team management becomes an obligation for all oncologic fields as mentioned by the French government law: cancer program 2003-2007, this program stipulate that each new patient should benefit from MDTM decision-making process, organize the setting of MDTM and also gives tools to develop trials of research for a new diagnosis and therapeutic arsenal (3). Some urologists express some doubt about the interest of MDTM because of it’s a new burden without assigned budget while others see in the MDTM an equalit y of chance of patients, and possibility to include patients in trials and protocols. Number of European study showed the interest of MDTM and its beneficial impact on survival (4, 5). The efficiency of decisions made at MDTM is obvious but the evidence about their reproducibility remains doubtful. Through patients underwent a radical prostatectomy (RP) for localized prostate cancer (PCa) and represented identically, we evaluated a reproducibility of decision made at MDTM.