Should Total Number of Lymph Nodes be Used as a Quality of Care Measure for Stage III Colon Cancer?

• DOI: 10.1097/sla.0b013e318197f2c8
• Publication Date: 2009-05-21T10:15:26Z
• Authors: Jiping Wang; Mahmoud Kulaylat; Howard Rockette; James Hassett; Ashwani Rajput; Kelli Bullard Dunn; Merril Dayton
• Keywords: Cancer Survival; Log-rank test

In Brief Objective: To assess whether TNODS is an independent prognostic factor after adjusting for the lymph node ratio (LNR). Summary Background Data: The medical literature has suggested that associated with better survival in stage II and III colon cancer. Thus was endorsed as a quality measure patient care by American College of Surgeons, National Quality Forum. There is, however, little biologic rationale to support this linkage. Methods: A total 24,477 cancer patients were identified from Surveillance, Epidemiology, End Results registry categorized into 4 groups, LNR1 LNR4, according LNR interval: <0.07, 0.07 0.25, 0.25 0.50, >0.50. Patients also stratified high (≥12) low (<12) groups. method Kaplan-Meier used estimate 5-year log-rank test difference among different Results: have compared those (5-year 51.0% vs. 45.0%, P < 0.0001). However, stratifying status, there no significant between within strata LNR2 56.3% 56.0%, = 0.26). Ironically, had significantly worse than LNR3 41.2% 47.4%, 0.0009) 22.0% 32.1%, Conclusions: previously reported effect on node-positive confounded LNR. This observation calls question use patients' care. well-documented association number nodes examined (TNODS) outcome ratio.