Inter-rater variability in multidisciplinary team meetings of oesophageal and gastro-oesophageal junction cancer on staging, resectability and treatment recommendation: national retrospective multicentre study

Abstract

Background: There are differences in oesophageal cancer care across Sweden. According to national guidelines, all patients should be offered equal care, planned and administrated by regional multidisciplinary team meetings. The aim of the study was to investigate differences between regional multidisciplinary team meetings in Sweden regarding clinical staging and treatment recommendations for oesophageal cancer patients.

Methods: All six Swedish regional multidisciplinary teams were each invited to retrospectively include ten consecutive oesophageal cancer cases. After anonymization, radiological investigations were presented, along with the original case-specific medical history, anew at the participating regional multidisciplinary team meetings. Estimation of clinical tumour node metastasis (TNM) classification and treatment recommendation (curative, palliative or best supportive care) were compared between multidisciplinary team meetings as well as with original assessments.

Results: Five multidisciplinary teams participated and contributed a total of 50 cases presented to each multidisciplinary team. In estimations of cT-stage, the multidisciplinary teams were in total agreement in only eight of 50 cases (16%). For cN-stage, total agreement was seen in 17 of 50 cases (34%) and for cM-stage there was agreement in 34 cases (68%). For cT-stage, the overall summarized κ value was 0.57. For N-stage and M-stage the κ values were 0.66 and 0.78 respectively. Differences in appraisal were not associated with usage of positron emission tomography-computed tomography. In 15 of 50 cases (30%) the multidisciplinary teams disagreed on curative or palliative treatment.

Conclusion: The study shows differences in assessment of clinical TNM classification and treatment recommendations made at regional multidisciplinary team meetings. Increased interrater agreement on clinical TNM classification and management plans are essential to achieve more equal care for oesophageal cancer patients in Sweden.

Fig. 1

Evaluations of: a clinical T-stage, b clinical N-stage, c clinical M-stage with five new assessments and one original cT-, cN- and cM-stage appraisal on the y-axis and a total of 50 study cases on the x-axis, arranged with more severe stages to the right. White dot = missing value, grey dot = TX/NX/MX, purple dots = T0–T4b, pink dots = N0–N3, green dots = M0–M1. Darker colours indicate a higher T/N/M-stage. Original MDT highlighted with a thicker line. MDT, multidisciplinary team meetings; NA, not assessed.

Fig. 2

Recommended treatment by MDT for study cases 1–50 Original MDT highlighted with a thicker line. MDT, multidisciplinary team meetings; NA, not assessed.