Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer

Figures & data

Figure 1. Patient inclusion and causes for exclusion in the different subsets.

Table I. Factors associated with preoperative MDT conference (n = 4883).

	n MDT/Total	Univariate analysis		p-value	Multivariate analysis		p-value
		OR	CI 95%		OR	CI 95%
Hospital volume
Very low	784/1175 (67%)	0.15	0.12–0.19	< 0.001	0.15	0.12–0.20	< 0.001
Low	1036/1303 (80%)	0.29	0.22–0.38	< 0.001	0.27	0.21–0.36	< 0.001
Intermediate	1107/1190 (93%)	1.00	REF		1.00	REF
High	1124/1200 (94%)	1.11	0.80–1.53	0.529	0.99	0.71–1.38	0.944
Unknown	12/15 (80%)	0.30	0.08–1.09	0.066	0.55	0.14–2.18	0.395
ASA grade
1	826/976 (85%)	0.86	0.70–1.06	0.157	0.84	0.66–1.06	0.135
2	2113/2443 (86%)	1.00	REF		1.00	REF
3	801/954 (84%)	0.82	0.66–1.01	0.058	0.82	0.65–1.04	0.098
4	46/63 (73%)	0.42	0.24–0.75	0.003	0.52	0.28–0.99	0.045
Unknown	277/447 (62%)	0.25	0.20–0.32	< 0.001	0.33	0.26–0.43	< 0.001
Age (years)
< 72	2284/2646 (86%)	1.00	REF		1.00	REF
72–79	1031/1223 (84%)	0.85	0.70–1.03	0.096	1.01	0.81–1.25	0.928
> 79	748/1014 (74%)	0.45	0.37–0.53	< 0.001	0.60	0.48–0.74	< 0.001
Gender
Woman	2398/2874 (83%)	0.96	0.83–1.12	0.606	0.98	0.83–1.17	0.825
Man	1665/2009 (83%)	1.00	REF		1.00	REF
Tumour stage
I–II	1091/1300 (84%)	0.59	0.48–0.73	< 0.001	0.54	0.43–0.67	< 0.001
III	1845/2055 (90%)	1.00	REF		1.00	REF
IV	707/780 (91%)	1.10	0.83–1.46	0.495	1.12	0.83–1.51	0.461
Unknown	420/748 (56%)	0.15	0.12–0.18	< 0.001	0.16	0.13–0.20	< 0.001

Patients with metastasis or with relevant data missing are excluded (Figure 1). The multivariate analysis is adjusted for hospital volume, ASA grade, age, gender and tumour stage but not for interactions. ASA, American Society of Anaesthesiologists; CI 95%, confidence interval of 95%; MDT, multidisciplinary team meeting; OR, odds ratio. Lowest tolerance statistic 0.650.

Table II. System- and patient-related factors in relation to preoperative radiotherapy (pT3c, pT3d and pT4 tumours, n = 1043).

	n RT/Total	Univariate analysis		p-value	Multivariate analysis		p-value
		OR	CI 95%		OR	CI 95%
MDT
Yes	729/939 (78%)	4.38	2.89–6.64	< 0.001	5.06	3.08–8.34	< 0.001
No	46/104 (44%)	1.00	REF		1.00	REF
Hospital volume
Very low	153/224 (68%)	0.77	0.52–1.15	0.202	1.21	0.76–1.94	0.428
Low	212/271 (78%)	1.29	0.86–1.93	0.226	2.03	1.28–3.22	0.003
Intermediate	179/243 (74%)	1.00	REF		1.00	REF
High	231/395 (76%)	1.12	0.76–1.64	0.578	1.02	0.66–1.56	0.939
Missing	0/0
ASA grade
1	152/188 (81%)	1.17	0.77–1.76	0.467	0.90	0.57–1.41	0.631
2	460/587 (78%)	1.00	REF		1.00	REF
3	143/239 (60%)	0.41	0.30–0.80	< 0.001	0.55	0.38–0.79	0.001
4	7/7 (50%)	0.28	0.10–0.80	0.276	0.28	0.08–0.90	0.033
Missing	13/15 (87%)	1.80	0.40–8.06	0.445	5.10	0.98–26.42	0.052
Age (years)
< 72	513/612 (84%)	1.00	REF		1.00	REF
72–79	178/258 (69%)	0.43	0.31–0.60	< 0.001	0.47	0.32–0.69	< 0.001
> 79	84/173 (49%)	0.18	0.13–0.26	< 0.001	0.20	0.13–0.31	< 0.001
Operation type
AR	330/451 (73%)	1.00	REF		1.00	REF
APE	311/370 (84%)	1.93	1.37–2.74	< 0.001	2.57	1.75–3.79	< 0.001
HA	134/222 (60%)	0.56	0.40–0.79	0.001	0.92	0.62–1.36	0.670

Patients with emergency resections or with relevant data missing are excluded (Figure 1). The multivariate analysis is adjusted for MDT, hospital volume, ASA grade, age and operation type but not for interactions. APE, abdominoperineal excision; AR, anterior resection; ASA, American Society of Anaesthesiologists; CI 95%, confidence interval of 95%; HA, Hartmann's procedure; MDT, multidisciplinary team meeting; OR, odds ratio; RT, preoperative radiotherapy (any kind). Lowest tolerance statistic 0.608.

Table III. System- and patient-related factors in relation to preoperative radiotherapy (N1 and pN2 tumours, n = 1991).

	n RT/Total	Univariate analysis		p-value	Multivariate analysis		p-value
		OR	CI 95%		OR	CI 95%
MDT
Yes	1283/1706 (75%)	3.83	2.96–4.96	< 0.001	3.55	2.60–4.85	< 0.001
No	126/285 (44%)	1.00	REF		1.00	REF
Hospital volume
Very low	320/506 (63%)	0.62	0.47–0.81	0.001	0.95	0.69–1.31	0.732
Low	397/552 (72%)	0.92	0.70–1.21	0.558	1.18	0.87–1.61	0.286
Intermediate	345/469 (74%)	1.00	REF		1.00	REF
High	347/464 (75%)	1.07	0.80–1.43	0.669	0.90	0.66–1.24	0.530
Missing	0/0
ASA grade
1	335/440 (76%)	1.16	0.90–1.50	0.248	0.84	0.63–1.12	0.228
2	809/1104 (73%)	1.00	REF		1.00	REF
3	217/381 (57%)	0.48	0.38–0.62	< 0.001	0.60	0.45–0.79	< 0.001
4	10/20 (50)	0.37	0.15–0.89	0.026	0.40	0.14–1.11	0.079
Missing	38/46 (83%)	1.73	0.80–3.76	0.164	3.10	1.31–7.34	0.010
Age (years)
< 72	953/1192 (80%)	1.00	REF		1.00	REF
72–79	332/479 (69%)	0.57	0.45–0.72	< 0.001	0.57	0.43–0.74	< 0.001
> 79	124/320 (39%)	0.16	0.12–0.21	< 0.001	0.16	0.12–0.22	< 0.001
Operation type
AR	644/956 (67%)	1.00	REF		1.00	REF
APE	595/717 (83%)	2.36	1.86–3.00	< 0.001	3.13	2.40–4.08	< 0.001
HA	170/318 (53%)	0.56	0.43–0.72	< 0.001	1.09	0.80–1.48	0.608

Patients with emergency resections or with relevant data missing are excluded (Figure 1). The multivariate analysis is adjusted for MDT, hospital volume, ASA grade, age and operation type but not for interactions. APE, abdominoperineal excision; AR, anterior resection; ASA, American Society of Anaesthesiologists; CI 95%, confidence interval of 95%; HA, Hartmann's procedure; MDT, multidisciplinary team meeting; OR, odds ratio; RT, preoperative radiotherapy (any kind). Lowest tolerance statistic 0.583.

Figure 2. MDT conference discussion in relation to hospital volume (same exclusion criteria as Table I).

Figure 3. MDT conference discussion in relation to preoperative radiotherapy for T3c-T4 tumours (left) and pN+ tumours (right).