Surgery remains a major treatment option in lung cancer in particular at early stages.
Recent Australian and UK studies have shown that patients with NSCLC were less likely to have surgery and more likely to die if they were first seen at a non-specialized surgical centre, or with increasing distance to the nearest specialist hospital. In France, not all general hospitals have a thoracic surgery department. We assessed the impact on patient outcome of the distance between the chest and thoracic surgery Departments.
KBP-2010-CPHG is a prospective multicentre epidemiological study promoted by the French College of General Hospital Respiratory Physicians (CPHG), including 7,051 patients followed for primary lung cancer diagnosed in 2010 in the chest department of 104 general hospitals. The distance from the usual thoracic surgery department in 2010 was collected for each chest department in 2015. Univariate and multivariate analyses were performed to identify independent factors for surgery and mortality. Distance was included in the model as a 4-class variable: 0 (same hospital), 1-34, 35-79, and ≥80 km.
23% of hospitals had a thoracic surgery department; otherwise, mean distance between the hospital and the surgical centre was 65 km. 6,083 patients had a NSCLC; 1157 (19%) were operated on. Independent factors for surgery were: young age, early disease, good performance status, and cancer histological type. Distance was not an independent factor for surgery: OR [95% CI] was 0.971 [0.74-1.274] (p = 0.833), 0.883 [0.662-1.178] (p = 0.399), and 1.015 [0.783-1.317] (p = 0.91) for 1-34, 35-79, and ≥80 km vs. 0 km. 1,939 patients had stage I to IIIA NSCLC; 1070 (55%) were operated on. Independent risk factors for mortality were old age, male gender, advanced disease, and poor performance status. Distance was not an independent risk factor for mortality: OR [95% CI] was 1.016 [0.83-1.244] (p = 0.878), 1.089 [0.882-1.344] (p = 0.427), and 1.011 [0.829-1.233] (p = 0.915) for 1-34, 35-79, and ≥80 km vs. 0 km.
In France, in 2010, the absence of an on-site thoracic surgery department did not impair outcome in NSCLC patients managed in the chest department of general hospitals.
Clinical trial identification
Legal entity responsible for the study
Collège des Pneumologues des Hopitaux Généraux (CPHG)
KBP-2010-CPHG is a study promoted by the CPHG with the help of the endowment fund Recherche en Santé Respiratoire of the CNMR and Pneumologie development, and funded by the following laboratories: AstraZeneca, BMS, Boehringer Ingelheim, Chugai, GlaxoSmithKline, Lilly France, Pierre Fabre Oncologie,Pfizer, Roche, and Sanofi-Aventis.
All authors have declared no conflicts of interest.