Impact of multidisciplinary team assessment on surgical outcome of non-small cell lung cancer: a real-life institutional experience

Abstract

Background
The introduction of new therapeutic strategies and diagnostic tools in recent years has radically modified the management of patients with non-small cell lung cancer (NSCLC). Most of the guidelines recommend a multidisciplinary assessment of this kind of patient to achieve a “tailored” treatment. Herein, we report our institutional experience after the introduction of a multidisciplinary team (MDT) assessment for patients with NSCLC.


Results
We retrospectively evaluated patients who underwent surgery for suspected or confirmed NSCLC in our hospital from April 2021 to September 2024. We compared patients previously discussed within our multidisciplinary meetings (MDT group) to the ones who underwent surgery in the 21 months before its introduction (pre-MDT group). The primary outcome was the assessment of the congruity between clinical and pathological staging. Secondary endpoints were comparison about final histological diagnosis, surgical intent, and pathological stage. A total of 497 consecutive patients were enrolled in this study, with 255 (51.3%) belonging to the MDT group and 242 (48.7%) to the pre-MDT group. In the MDT group, there was a higher concordance between clinical and pathological staging, with only 8/255 cases of up- or downstaging (3.1%) versus 26/242 cases (10.7%) in the pre-MDT group (p < 0.001). Particularly, we recorded only 4 cases of upstaging in the MDT group versus 18 cases in the other one (p = 0.003). After the introduction of MDT, there was a significant reduction in surgery performed for benign lesions (18.8% versus 30.2%, p = 0.003) as well as surgery with diagnostic intent only (21.3% versus 30.2%, p = 0.048). Considering patients who underwent intentionally curative surgery, after MDT introduction, there was a significant increase in early-stage diagnosis (p = 0.003) and, among stage I patients, a significant increase in pT1a (15.1% versus 2.5%) together with a reduction in pT2a (23.8% versus 46.2%) with p = 0.007.


Conclusions
The introduction of MDT in our institution was related to a better congruity between clinical and final pathological stages. Furthermore, MDT case discussion has led to a reduction of surgical procedures performed for either benign pulmonary lesions or diagnostic purposes in patients with advanced stages, thus allowing an increase of intentionally curative resections for early stages of thedisease.