Debieuvre Didier, Fraboulet Gislaine, Duvert Bernard, Piquet Jacques, Goarant Eric, Sandron Daniel, Mouroux-Rotomondo Christine, Borrel Bernard, Genety Camille, Kassem Ghassan-Jacques, Grivaux Michel
Groupe hospitalier de la région Mulhouse Sud-Alsace, hôpital Émile-Muller, département de pneumologie, 68070 Mulhouse, France.
Centre hospitalier René-Dubos, service d'oncohématologie, 95301 Cergy-Pontoise, France.
Bull Cancer. 2017 Oct;104(10):840-849. doi: 10.1016/j.bulcan.2017.07.008. Epub 2017 Sep 29.
Increased postoperative mortality in low volume centers has contributed to merge and space thoracic surgical centers. Some studies have showed that the likelihood of receiving surgery was lower in lung cancer patients living far from a thoracic surgery center. Our objective was thus to determine whether surgery and survival rates in patients with non-small-cell lung cancer (NSCLC) were influenced by the distance between the respiratory and thoracic surgery departments.
KBP-2010-CPHG is a prospective multicenter epidemiological study including 6083 patients followed in 104 nonacademic hospitals for primary NSCLC diagnosed in 2010. Distance between respiratory and thoracic surgery departments were obtained retrospectively. Predictive factors for surgery and mortality were identified by logistic regression and Cox hazard model.
Twenty-three percent of hospitals had a thoracic surgery department; otherwise, mean distance between the hospital and the surgery center was 65km. Nineteen percent of patients underwent surgery. Distance was neither an independent factor for surgery (odds-ratios [95% CI]: 0.971 [0.74-1.274], 0.883 [0.662-1.178], and 1.015 [0.783-1.317] for 1-34, 35-79, and ≥80km vs. 0km) nor for mortality (hazard-ratios [95% CI]: 1.020 [0.935-1.111], 1.003 [0.915-1.099], and 1.006 [0.927-1.091]) (P>0.05).
This result supports the French national strategy which merges surgery departments and should reassure patients (and physicians) who could be afraid to be lately addressed to surgery or loose chance when being followed far from the thoracic surgical center.
低容量中心术后死亡率增加促使胸外科中心合并及整合空间。一些研究表明，居住在远离胸外科中心的肺癌患者接受手术的可能性较低。因此，我们的目的是确定非小细胞肺癌（NSCLC）患者的手术及生存率是否受呼吸内科与胸外科之间距离的影响。
KBP - 2010 - CPHG是一项前瞻性多中心流行病学研究，纳入了2010年在104家非学术医院确诊为原发性NSCLC的6083例患者。呼吸内科与胸外科之间的距离通过回顾性方法获取。通过逻辑回归和Cox风险模型确定手术及死亡率的预测因素。
23%的医院设有胸外科；否则，医院与手术中心之间的平均距离为65公里。19%的患者接受了手术。距离既不是手术的独立因素（优势比[95%可信区间]：对于距离0公里分别为1 - 34公里、35 - 79公里和≥80公里时为0.971[0.74 - 1.274]、0.883[0.662 - 1.178]和1.015[0.783 - 1.317]），也不是死亡率的独立因素（风险比[95%可信区间]：1.020[0.935 - 1.111]、1.003[0.915 - 1.099]和1.006[0.927 - 1.091]）（P>0.05）。
这一结果支持了法国合并外科科室的国家战略，应能让那些可能担心因距离胸外科中心远而延迟手术或失去手术机会的患者（及医生）安心。
