Rea Federico, Ieva Francesca, Pastorino Ugo, Apolone Giovanni, Barni Sandro, Merlino Luca, Franchi Matteo, Corrao Giovanni
National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.
Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
Eur J Cardiothorac Surg. 2020 Jul 1;58(1):70-77. doi: 10.1093/ejcts/ezaa031.
Although it has been postulated that patients might benefit from the centralization of high-volume specialized centres, conflicting results have been reported on the relationship between the number of lung resections performed and the long-term, all-cause mortality rates among patients who underwent surgery for lung cancer. A population-based observational study was performed to contribute to the ongoing debate.
The 2613 patients, all residents of the Lombardy region (Italy), who underwent lung resection for lung cancer from 2012 to 2014 were entered into the cohort and were followed until 2018. The hospitals were classified according to the annual number of pulmonary resections performed. Three categories of lung resection cases were identified: low (≤30), intermediate (31-95) and high (>95). The outcome of interest was all-cause death. A frailty model was used to estimate the death risk associated with the categories of numbers of lung resections performed, taking into account the multilevel structure of the data. A set of sensitivity analyses was performed to account for sources of systematic uncertainty.
The 1-year and 5-year survival rates of cohort members were 90% and 63%. Patients operated on in high-volume centres were on average younger and more often women. Compared to patients operated on in a low-volume centre, the mortality risk exhibited a significant, progressive reduction as the numbers of lung resections performed increased to intermediate (-13%; 95% confidence interval +10% to -31%) and high (-26%; 0% to -45%). Sensitivity analyses revealed that the association was consistent.
Further evidence that the volume of lung resection cases performed strongly affects the long-term survival of lung cancer patients has been supplied.
尽管有人推测患者可能会从高容量专科中心的集中化中受益，但关于肺癌手术患者的肺切除数量与长期全因死亡率之间的关系，已有相互矛盾的结果报道。开展了一项基于人群的观察性研究，以助力正在进行的辩论。
将2012年至2014年在意大利伦巴第地区接受肺癌肺切除术的2613名患者纳入队列，并随访至2018年。根据每年进行的肺切除数量对医院进行分类。确定了三类肺切除病例：低（≤30例）、中（31 - 95例）和高（>95例）。感兴趣的结局是全因死亡。使用脆弱模型来估计与所进行的肺切除数量类别相关的死亡风险，同时考虑数据的多层次结构。进行了一组敏感性分析以考虑系统不确定性的来源。
队列成员的1年和5年生存率分别为90%和63%。在高容量中心接受手术的患者平均更年轻，女性比例更高。与在低容量中心接受手术的患者相比，随着肺切除数量增加到中等（-13%；95%置信区间为 +10%至 -31%）和高（-26%；0%至 -45%），死亡风险显著逐步降低。敏感性分析表明这种关联是一致的。
提供了进一步的证据，表明所进行的肺切除病例数量强烈影响肺癌患者的长期生存。
