ObjectiveTo explore the predictive value of metastatic lymph node ratio (MLNR) on prognosis of patients with gastric cancer after radical gastrectomy, and to evaluate whether MLNR can be used as a reference tool to guide the formulation of postoperative adjuvant treatment strategies and prognosis prediction of gastric cancer.MethodsThe clinicopathologic features of patients who underwent D2 radical gastrectomy from January 2014 to December 2017 were retrospectively analyzed. The factors influencing the disease specific survival of gastric cancer were analyzed by Cox proportional hazards model, then the variables with statistical significance in multivariate analysis were included in the construction of nomograms model for prognosis of patients with gastric cancer.ResultsA total of 262 patients with gastric cancer were included. There was no correlation between MLNR and total number of lymph nodes (rs=0.037, P=0.547), there was a positive correlation between MLNR and pN stage (rs=0.909, P<0.001). Multivariate Cox regression analysis showed that pT stage, pN stage, MLNR, and postoperative chemotherapy were the independent predictors of prognosis of gastric cancer after radical gastrectomy. Four variables including pT stage, pN stage, postoperative chemotherapy, and MLNR were included in the construction of nomogram model, the C index of MLNR and pN stage model was 0.707 and 0.692 respectively. Survival analysis showed that the higher the MLNR, the worse the prognosis.ConclusionsThe ability of MLNR to predict prognosis of gastric cancer might be better than pN stage. Therefore, it is considered that MLNR could be used as an important evaluation tool to guide adjuvant treatment and prognosis prediction after radical gastrectomy.
In response to the current situation of regional medical and health hierarchical diagnosis and treatment services and the existing problems in the continuity of medical services, this article applies supply chain management methods, system collaboration theory, and service ecosystem concepts to treat medical consortia as an organic whole. Based on the quality and efficiency of disease management in the whole life cycle of patients with difficult, complex and severe diseases, a multi-level and multi-disciplinary medical service supply chain model of difficult, complex and severe disease medical consortium is constructed with four core elements: patient flow, service flow, technology flow and information flow. This article provides a certain reference for the implementation of regional hierarchical diagnosis and treatment and the formulation of relevant policies in China from the perspective of theoretical research.
Multi-disciplinary team (MDT) is a leading diagnosis and treatment model widely respected in modern international medical field, which plays an important role in clarifying disease diagnosis, determining treatment direction, and reducing patient time and labor cost. In recent years, China has issued relevant policies to encourage hospitals to vigorously develop MDT. West China Hospital of Sichuan University established a MDT clinic in 2013. Through continuous innovation and bold breakthrough in terms of experience accumulation, clinical resource integration, disciplinary collaboration and other aspects, the hospital breaks the barriers of MDT, timely helps complex severe diseases patients to solve the diagnosis and treatment needs, provides patients with the best personalized treatment plan, and continuously improves the medical experience of patients. Therefore, this article introduces and summarizes the implementation process and experience of MDT outpatient clinic in West China Hospital of Sichuan University.
Under the policy background of deepening the reform of the hierarchical diagnosis and treatment system in the country, large public hospitals, as centers for the diagnosis and treatment of difficult and severe diseases, face multiple challenges such as difficulty in patient appointment, difficulty in precise diagnosis and treatment, and difficulty in continuous medical care. To overcome this series of severe challenges, West China Hospital of Sichuan University has established a “panoramic” outpatient diagnosis and treatment service system for difficult and severe diseases based on the pain points of patients seeking medical treatment. This system optimizes the entire diagnosis and treatment process through innovative measures such as pre-diagnosis “three convergences”, during-diagnosis “three guarantees”, and post-diagnosis “three connections”. It not only significantly improves the efficiency and quality of diagnosis and treatment, but also provides patients with a high-quality and convenient medical service experience, offering a practical example for large public hospitals to address the diagnosis and treatment challenges of difficult and severe diseases.