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Cancer Resources > Cancer News > 2007 > November
Number of lymph nodes examined does not influence colon cancer survival
Last Updated: 2007-11-13 16:00:23 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Hospitals vary widely in the number of lymph nodes examined following resection for colon cancer, a new study indicates. However, it appears that this does not influence how long patients live.
Since several cancer organizations recently endorsed a 12-node minimum with colectomy for colon cancer as a consensus standard for hospital-based performance, "there are potentially important implications of our study," Dr. Sandra L. Wong, from the University of Michigan, Ann Arbor, noted in comments to Reuters Health.
"Our findings raise questions about the value of lymph node counts as a hospital quality indicator," she said.
Dr. Wong and colleagues studied hospital lymph node examination rates and survival among 30,625 patients who underwent curative resection of nonmetastatic colon cancer. They did this by linking national Surveillance, Epidemiology, and End Results (SEER) and Medicare data for the period 1995 to 2003.
After adjusting for potentially confounding factors, the researchers were unable to find a statistically significant relationship between hospital lymph node examination rates and use of adjuvant chemotherapy or survival after surgery.
There was no evidence of higher 5-year survival at hospitals examining a higher number of lymph nodes, the team reports in the November 14 issue of the Journal of the American Medical Association.
The reason for this finding, the investigators suggest, may be simple: "Regardless of how many lymph nodes hospitals examined, they tended to find the same number of node-positive ones. As a result, higher hospital lymph node examination rates did not result in greater detection of patients with node-positive tumors or higher rates of adjuvant chemotherapy," they explain.
"The results were somewhat surprising," Dr. Wong acknowledged. "There is a lot of emphasis being placed on this quality indicator as a means of improving care for colon cancer patient. What we saw suggests no benefit from hospitals using the 12-node minimum," she added.
In an accompanying editorial, Dr. Marko Simunovic of McMaster University, Hamilton, Ontario, Canada, and Dr. Nancy N. Baxter, of the University of Toronto sound a word of caution, writing that "researchers should not abandon efforts to identify potentially useful quality indicators through various study designs."
JAMA 2007;298:2149-2154,2194-2195.
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