Background
Survival in colon cancer is greater in those patients who have more lymph nodes identified
at resection and may be due to stage migration, confounding by treatment, social,
or clinical characteristics. Identifying factor(s) responsible for the effect may
represent an opportunity to improve quality of care for patients with colon cancer
by increasing node counts in specimens.
Methods
Cox proportional hazards models were created to analyze survival of 11,399 patients
with stage I-III colon cancer from the Surveillance, Epidemiology and End Results
(SEER)-Medicare database. The primary predictor variable was the number of lymph nodes
identified. The models allowed adjustment for patient factors, use of chemotherapy,
surgical specialty, and the average number of nodes identified by surgeon and hospital
pathologist.
Results
The number of nodes identified was related to survival. Compared to those with less
than 7 nodes, patients with 7 to 11 nodes had a 13% lesser risk of death (hazard ratio
[HR], 0.87; 95% confidence interval [CI], 0.76–0.99; P = .037). Patients with more than 12 nodes had a 17% lesser risk (HR, 0.83; 95% CI,
0.73–0.95; P = .005). Adjusting for selected patient demographic characteristics, receipt of chemotherapy,
surgical specialty, and the average number of nodes identified per specimen by the
surgeon or hospital did not significantly alter the relationship between number of
nodes and survival.
Conclusion
These findings argue against understaging or confounding as the explanation for the
inferior survival observed in patients with fewer nodes identified. National initiatives
to increase the number of nodes identified in colon cancer specimens may not improve
substantially the cancer-specific outcomes.
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Article info
Publication history
Published online: December 04, 2009
Accepted:
October 2,
2009
Footnotes
Supported in part by research grants from the National Institutes of Health (K30 RR22260 and K24 DK68380).
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
