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

Fig. 1. Standardised resection ratio for each Clinical Commissioning Group adjusting for variables listed in the title of each graph, excluding patients with cancer stage 3B, 4 or missing (n = 57,373). CVD cardiovascular disease comorbidity before cancer diagnosis, IMD Index of Multiple Deprivation, CCI Charlson Comorbidity Index (excluding CVD). Red points indicate geographical regions (i.e. clinical commissioning groups) with greater than three standard deviations from target standardised resection ratio of 1. Points with the same number indicate the same region in each funnel plot.

Fig. 2. Association between CVD procedure or diagnosis and time from NSCLC diagnosis to resection, compared to no CVD, in progressively adjusted models (n = 48,950)*. *Excluding patients with cancer stage 3B, 4 or missing and patients with only hypertension or non-interventional procedure. CVD procedures: CABG, PCI or valve surgery, CVD cardiovascular disease, IMD Index of Multiple Deprivation, CCI Charlson Comorbidity Index (excluding CVD).

Fig. 3. Association between CVD procedure or diagnosis and time from resection to mortality, compared to no CVD codes, in progressively adjusted models (n = 18,648)*. *Excluding patients with cancer stage 3B, 4 or missing and patients with only hypertension or non-interventional procedure. CVD procedures: CABG, PCI or valve surgery, CVD cardiovascular disease, IMD Index of Multiple Deprivation, CCI Charlson Comorbidity Index (excluding CVD).

Fig. 4. Effect of increasing propensity of resection in geographical regions in the lowest fifth of resection on the probability of ever being resected and all-cause mortality in the 6 years following NSCLC diagnosis for patients with CVD comorbidity (n = 30,040)*. *Excluding patients with cancer stage 3B, 4 or missing and patients with only hypertension or non-interventional procedure or no CVD. Adjusted for age, sex, cancer stage, calendar year, Index of Multiple Deprivation, Charlson Comorbidity Index (excluding CVD diagnosis codes) and regional resection fifth.

Fig. 5. Predicted outcomes for NSCLC patients one year after cancer diagnosis. The 100 faces represent the percentage of patients with outcomes as identified in the key. Top panel: patients in the regional fifth with the lowest resection rate. Bottom panel: patients in the regional fifth with the lowest resection rate if they had the same resection rate as the regional fifty with the highest resection rate.