Li Wilson W L, Visser Otto, Ubbink Dirk T, Klomp Houke M, Kloek Jaap J, de Mol Bas A J M
Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Lung Cancer. 2008 Jun;60(3):441-51. doi: 10.1016/j.lungcan.2007.10.029. Epub 2007 Dec 27.
Surgery remains the mainstay of treatment for localized non-small cell lung cancer (NSCLC). However, wide variations have been reported regarding rates of operative therapy. We examined the influence of characteristics of the hospital of diagnosis on the likelihood of receiving surgical treatment and on survival. We evaluated patients with primary, first-time, localized NSCLC diagnosed from 1998 to 2003 in the region of the Amsterdam Cancer Registry. Treatment and survival data were extracted from the registry database. We investigated which provider characteristics (hospital category, mean annual lung cancer caseload, presence of a cardiothoracic surgery unit) were predictive of receiving surgical treatment and of survival. 1591 patients were diagnosed with clinically localized NSCLC, of which 1097 (69%) had surgery. Resection rates varied significantly between the various hospitals (48-90%, chi(2), P<0.001). Patients diagnosed at specialized centers or higher volume hospitals were more likely to receive surgical therapy, especially for patients over 80 years of age. In addition, there was a trend that octogenarians had higher odds of undergoing surgery when diagnosed in a center with a cardiothoracic surgery unit. Patients had a better survival after resection than without surgery (P<0.001). Survival after surgery did not differ between the various hospital categories. In conclusion, there is wide institutional variability in rates of surgical treatment in lung cancer patients. In addition to patient characteristics, attributes of the hospital of diagnosis also have significant influence on the likelihood of receiving surgical therapy. Future studies should examine the underlying mechanisms for this phenomenon.
手术仍然是局限性非小细胞肺癌（NSCLC）治疗的主要手段。然而，关于手术治疗率的报道存在很大差异。我们研究了诊断医院的特征对接受手术治疗的可能性及生存的影响。我们评估了1998年至2003年在阿姆斯特丹癌症登记处区域诊断为原发性、首次、局限性NSCLC的患者。治疗和生存数据从登记数据库中提取。我们调查了哪些医疗机构特征（医院类别、年均肺癌病例数、是否设有心胸外科）可预测接受手术治疗的可能性及生存情况。1591例患者被诊断为临床局限性NSCLC，其中1097例（69%）接受了手术。各医院之间的切除率差异显著（48 - 90%，卡方检验，P<0.001）。在专科中心或病例数较多的医院诊断的患者更有可能接受手术治疗，尤其是80岁以上的患者。此外，有一个趋势是，80岁老人在设有心胸外科的中心诊断时接受手术的几率更高。接受手术的患者比未接受手术的患者生存情况更好（P<0.001）。不同医院类别之间手术后的生存率没有差异。总之，肺癌患者的手术治疗率在不同机构之间存在很大差异。除了患者特征外，诊断医院的属性对接受手术治疗的可能性也有显著影响。未来的研究应探讨这一现象的潜在机制。
