King's College London School of Medicine, London.
J Clin Oncol. 2013 Sep 1;31(25):3141-6. doi: 10.1200/JCO.2013.49.0219. Epub 2013 Jul 29.
Studies have reported an association between hospital volume and survival for non-small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect.
We analyzed data on 134,293 patients with NSCLC diagnosed in England between 2004 and 2008, of whom 12,862 (9.6%) underwent surgical resection. Hospital volume was defined according to number of patients with resected lung cancer in each hospital in each year of diagnosis. We calculated hazard ratios (HRs) for death in three predefined periods according to hospital volume, sex, age, socioeconomic deprivation, comorbidity, and propensity to resect.
There was increased survival in hospitals performing > 150 surgical resections compared with those carrying out < 70 (HR, 0.78; 95% CI, 0.67 to 0.90; Ptrend < .01). The association between hospital volume and survival was present in all three periods of follow-up, but the magnitude of association was greatest in the early postoperative period.
High-volume hospitals have higher resection rates and perform surgery among patients who are older, have lower socioeconomic status, and have more comorbidities; despite this, they achieve better survival, most notably in the early postoperative period.
已有研究报道非小细胞肺癌（NSCLC）的医院容量与生存率之间存在关联。我们在考虑病例组合和可切除性的情况下，在英国对此相关性进行了探索。
我们分析了 2004 年至 2008 年间在英国诊断为 NSCLC 的 134293 例患者的数据，其中 12862 例（9.6%）接受了手术切除。根据每个医院每年诊断的接受肺癌切除术患者的数量定义医院容量。我们根据医院容量、性别、年龄、社会经济剥夺程度、合并症和可切除性，计算了三个预设时间段内死亡的风险比（HR）。
与手术量<70 例的医院相比，手术量>150 例的医院的生存率更高（HR，0.78；95%CI，0.67 至 0.90；Ptrend<.01）。医院容量与生存率之间的关联存在于所有三个随访期，但在术后早期关联程度最大。
高容量医院的切除术比例较高，且为年龄较大、社会经济地位较低和合并症较多的患者实施手术；尽管如此，它们仍能获得更好的生存率，尤其是在术后早期。
