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Impact on survival of modelling increased surgical resection rates in patients with Non-Small Cell Lung Cancer and cardiovascular comorbidities: a VICORI study

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journal contribution
posted on 17.12.2020, 08:48 by Catherine Welch, Michael Sweeting, Paul Lambert, Mark Rutherford, Ruth Jack, Douglas West, David Adlam, Michael Peake

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.

Funding

The study was funded by a joint research grant from the British Heart foundation 405 (SP/16/5/32415) and Cancer Research UK (C53325/A21134).

History

Citation

British Journal of Cancer, volume 123, pages 471–479 (2020)

Author affiliation

College of Life Sciences

Version

VoR (Version of Record)

Published in

British Journal of Cancer

Volume

123

Pagination

471-479

Publisher

Springer Nature [academic journals on nature.com]

issn

0007-0920

eissn

1532-1827

Acceptance date

13/03/2020

Copyright date

2020

Available date

11/05/2020

Language

en

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