Impact on survival of modelling increased surgical resection rates in patients with non-small-cell lung cancer and cardiovascular comorbidities: a VICORI study

Welch, Catherine A.; Sweeting, Michael J.; Lambert, Paul C.; Rutherford, Mark J.; Jack, Ruth H.; West, Douglas; Adlam, David; Peake, Michael

Abstract

©2020, The Author(s). Background: The impact of cardiovascular disease (CVD) comorbidity on resection rates and survival for patients with early-stage non-small-cell lung cancer (NSCLC) is unclear. We explored if CVD comorbidity explained surgical resection rate variation and the impact on survival if resection rates increased. Methods: Cancer registry data consisted of English patients diagnosed with NSCLC from 2012 to 2016. Linked hospital records identified CVD comorbidities. We investigated resection rate variation by geographical region using funnel plots; resection and death rates using time-to-event analysis. We modelled an increased propensity for resection in regions with the lowest resection rates and estimated survival change. Results: Among 57,373 patients with Stage 1−3A NSCLC, resection rates varied considerably between regions. Patients with CVD comorbidity had lower resection rates and higher mortality rates. CVD comorbidity explained only 1.9% of the variation in resection rates. For every 100 CVD comorbid patients, increasing resection in regions with the lowest rates from 24 to 44% would result in 16 more patients resected and alive after 1 year and two fewer deaths overall. Conclusions: Variation in regional resection rate is not explained by CVD comorbidities. Increasing resection in patients with CVD comorbidity to the levels of the highest resecting region would increase 1-year survival.

• Journal Article Type: Article
• Acceptance Date: Apr 16, 2020
• Online Publication Date: May 11, 2020
• Publication Date: Aug 4, 2020
• Deposit Date: May 11, 2020
• Publicly Available Date: May 12, 2020
• Journal: British Journal of Cancer
• Print ISSN: 0007-0920
• Electronic ISSN: 1532-1827
• Publisher: Cancer Research UK
• Peer Reviewed: Peer Reviewed
• Volume: 123
• Pages: 471–479
• DOI: https://doi.org/10.1038/s41416-020-0869-8
• Keywords: Cancer Research; Oncology
• Public URL: https://nottingham-repository.worktribe.com/output/4418833
• Publisher URL: https://www.nature.com/articles/s41416-020-0869-8