Should Total Number of Lymph Nodes be Used as a Quality of Care Measure for Stage III Colon Cancer?
Adult
Aged, 80 and over
Male
Analysis of Variance
Age Factors
Middle Aged
Prognosis
Combined Modality Therapy
Disease-Free Survival
3. Good health
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Colonic Neoplasms
Humans
Lymph Node Excision
Female
Neoplasm Invasiveness
Lymph Nodes
Aged
Neoplasm Staging
Probability
Proportional Hazards Models
DOI:
10.1097/sla.0b013e318197f2c8
Publication Date:
2009-05-21T10:15:26Z
AUTHORS (7)
ABSTRACT
To assess whether TNODS is an independent prognostic factor after adjusting for the lymph node ratio (LNR).The medical literature has suggested that the TNODS is associated with better survival in stage II and III colon cancer. Thus TNODS was endorsed as a quality measure for patient care by American College of Surgeons, National Quality Forum. There is, however, little biologic rationale to support this linkage.: A total of 24,477 stage III colon cancer patients were identified from Surveillance, Epidemiology, and End Results cancer registry and categorized into 4 groups, LNR1 to LNR4, according to LNR interval: <0.07, 0.07 to 0.25, 0.25 to 0.50, and >0.50. Patients were also stratified according to TNODS into high TNODS (> or = 12) and low TNODS (<12) groups. The method of Kaplan-Meier was used to estimate the 5-year survival and the log-rank test was used to test the survival difference among the different groups.Patients with high TNODS have better survival compared with those with low TNODS (5-year survival 51.0% vs. 45.0%, P < 0.0001). However, after stratifying by LNR status, there was no significant survival difference between patients with high TNODS and those with low TNODS within strata LNR2 (5-year survival 56.3% vs. 56.0%, P = 0.26). Ironically, patients with high TNODS had significantly worse survival than those with low TNODS within strata LNR3 (5-year survival 41.2% vs. 47.4%, P = 0.0009) and LNR 4 (5-year survival 22.0% vs. 32.1%, P < 0.0001).The previously reported prognostic effect of TNODS on node-positive colon cancer was confounded by LNR. This observation calls into question the use of TNODS as a quality measure for colon cancer patients' care.
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