© 2005 Oxford University Press
ARTICLE |
Lymph Node Evaluation in Colorectal Cancer Patients: A Population-Based Study
Affiliations of authors: Division of Colon and Rectal Surgery, Department of Surgery (NNB, DJV, DAR), Department of Pathology (JJ), Division of Health Services Research (BAV), University of Minnesota, Minneapolis, MN; Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI (AMM)
Correspondence to: Nancy Baxter, MD, PhD, MMC 450, Division of Surgical Oncology, Department of Surgery, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455 (e-mail: baxte025{at}umn.edu).
Background: Adequate lymph node evaluation is required for proper staging of colorectal cancer, and the number of lymph nodes examined is associated with survival. According to current guidelines, the recommended minimum number of lymph nodes examined to ensure adequate sampling is 12. We used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program to determine the proportion of colorectal cancer patients in the United States who receive adequate lymph node evaluation. Methods: For 116 995 adults with colorectal adenocarcinoma, diagnosed from 1988 through 2001, who underwent radical surgery and did not receive neoadjuvant radiation, we evaluated the number of lymph nodes, the likelihood of receiving adequate lymph node evaluation (i.e., at least 12 lymph nodes examined), and the influence of tumor and patient factors on lymph node evaluation. All statistical tests were two-sided. Results: Among all patients, the median number of lymph nodes examined was nine. Only 37% of all patients received adequate lymph node evaluation. The proportion of patients receiving adequate lymph node evaluation increased from 32% in 1988 to 44% in 2001 (Ptrend<.001, Cochran–Armitage test). Advanced tumor stage was statistically significantly associated with adequate lymph node evaluation (odds ratio [OR] of receiving adequate lymph node evaluation=2.27, 95% confidence interval [CI] = 2.18 to 2.35). Older patients (
71 years, OR = 0.45, 95% CI = 0.44 to 0.47) were less likely to receive adequate lymph node evaluation than younger patients, and those with left-sided (OR = 0.45, 95% CI = 0.44 to 0.47) or rectal (OR = 0.52, 95% CI = 0.50 to 0.54) cancers were less likely to receive adequate lymph node evaluation than patients with right-sided cancers. In all analyses, geographic location was an important predictor of adequate lymph node evaluation, which ranged from 33% to 53%, depending on geographic location. Conclusions: In 2001, the majority of patients with colorectal cancer still received inadequate lymph node evaluation. The association of demographic variables, particularly patient age and geographic location, with adequate lymph node evaluation indicates that local surgical and pathology practice patterns may affect adequacy of lymph node evaluation.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Ogino, K. Nosho, N. Irahara, J. A. Meyerhardt, Y. Baba, K. Shima, J. N. Glickman, C. R. Ferrone, M. Mino-Kenudson, N. Tanaka, et al. Lymphocytic Reaction to Colorectal Cancer Is Associated with Longer Survival, Independent of Lymph Node Count, Microsatellite Instability, and CpG Island Methylator Phenotype Clin. Cancer Res., October 15, 2009; 15(20): 6412 - 6420. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Kukreja, E. Esteban-Agusti, J. M. Velasco, and T. J. Hieken Increased Lymph Node Evaluation With Colorectal Cancer Resection: Does It Improve Detection of Stage III Disease? Arch Surg, July 1, 2009; 144(7): 612 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Gondos, F. Bray, T. Hakulinen, H. Brenner, and the EUNICE Survival Working Group Trends in cancer survival in 11 European populations from 1990 to 2009: a model-based analysis Ann. Onc., March 1, 2009; 20(3): 564 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L H Iversen, S Laurberg, R Hagemann-Madsen, and H Dybdahl Increased lymph node harvest from colorectal cancer resections using GEWF solution: a randomised study J. Clin. Pathol., November 1, 2008; 61(11): 1203 - 1208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Y. Bilimoria, D. J. Bentrem, A. K. Stewart, M. S. Talamonti, D. P. Winchester, T. R. Russell, and C. Y. Ko Lymph Node Evaluation as a Colon Cancer Quality Measure: A National Hospital Report Card J Natl Cancer Inst, September 17, 2008; 100(18): 1310 - 1317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Y. Bilimoria, M. S. Talamonti, J. D. Wayne, J. S. Tomlinson, A. K. Stewart, D. P. Winchester, C. Y. Ko, and D. J. Bentrem Effect of Hospital Type and Volume on Lymph Node Evaluation for Gastric and Pancreatic Cancer Arch Surg, July 1, 2008; 143(7): 671 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Grote, A. H. Hughes, C. C. Rimmer, D. A. Less, A. P. Abernethy, and Multidisciplinary Gastrointestinal Tumor Board, De Targeting Lymph Node Retrieval and Assessment in Stage II Colon Cancer: A Quality Outcome Community-Based Cancer Center Study J. Oncol. Pract, March 1, 2008; 4(2): 55 - 58. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. C. Compton Optimal Pathologic Staging: Defining Stage II Disease Clin. Cancer Res., November 15, 2007; 13(22): 6862s - 6870s. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J A Morris, N. J Maughan, D. Forman, and P. Quirke Who to treat with adjuvant therapy in Dukes B/stage II colorectal cancer? The need for high quality pathology Gut, October 1, 2007; 56(10): 1419 - 1425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Sezeur, F.P. Chatelet, Ch. Cywiner, Cl. de Labriolle-Vaylet, C. Chastang, Cl. Billotey, M. Malafosse, D. Gallot, P. Betton, F. Montravers, et al. Pathology Underrates Colon Cancer Extranodal and Nodal Metastases; Ex vivo Radioimmunodetection Helps Staging Clin. Cancer Res., September 15, 2007; 13(18): 5592s - 5597s. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. A. Morris, N. J. Maughan, D. Forman, and P. Quirke Identifying Stage III Colorectal Cancer Patients: The Influence of the Patient, Surgeon, and Pathologist J. Clin. Oncol., June 20, 2007; 25(18): 2573 - 2579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Chang, M. A. Rodriguez-Bigas, J. M. Skibber, and V. A. Moyer Lymph Node Evaluation and Survival After Curative Resection of Colon Cancer: Systematic Review J Natl Cancer Inst, March 21, 2007; 99(6): 433 - 441. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Lemmens, I van Lijnschoten, M. Janssen-Heijnen, H. Rutten, C. Verheij, and J-W. Coebergh Pathology practice patterns affect lymph node evaluation and outcome of colon cancer: a population-based study Ann. Onc., December 1, 2006; 17(12): 1803 - 1809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Johnson, G. A. Porter, R. Ricciardi, and N. N. Baxter Increasing Negative Lymph Node Count Is Independently Associated With Improved Long-Term Survival in Stage IIIB and IIIC Colon Cancer J. Clin. Oncol., August 1, 2006; 24(22): 3570 - 3575. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Schulz, T. Hyslop, J. Haaf, C. Bonaccorso, K. Nielsen, M. E. Witek, R. Birbe, J. Palazzo, D. Weinberg, and S. A. Waldman A Validated Quantitative Assay to Detect Occult Micrometastases by Reverse Transcriptase-Polymerase Chain Reaction of Guanylyl Cyclase C in Patients with Colorectal Cancer Clin. Cancer Res., August 1, 2006; 12(15): 4545 - 4552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Mescoli, M Rugge, S Pucciarelli, V M Russo, G Pennelli, M Guido, and D Nitti High prevalence of isolated tumour cells in regional lymph nodes from pN0 colorectal cancer J. Clin. Pathol., August 1, 2006; 59(8): 870 - 874. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. O'Connell, M. A. Maggard, and C. Y. Ko RESPONSE: Re: Colon Cancer Survival Rates With the New American Joint Committee on Cancer Sixth Edition Staging J Natl Cancer Inst, November 16, 2005; 97(22): 1706 - 1707. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Wong, D. S. Johnson, D. Hemmings, A. Hsu, T. Imai, and G. T. Tominaga Assessing the Quality of Colorectal Cancer Staging: Documenting the Process in Improving the Staging of Node-Negative Colorectal Cancer Arch Surg, September 1, 2005; 140(9): 881 - 887. [Abstract] [Full Text] [PDF]
|
|