Staging error does not explain the relationship between the number of lymph nodes in a colon cancer specimen and survival
Staging error does not explain the relationship between the number of lymph nodes in a colon cancer specimen and survival
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DOI：
10.1016/j.surg.2009.10.003
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发表时间：
2010-03-01
期刊：
影响因子：
3.8
通讯作者：
Littenberg, Benjamin
中科院分区：
文献类型：
--
作者：
Moore, Jesse;Hyman, Neil;Littenberg, Benjamin
背景结肠癌的生存率在。在切除术中识别出更多淋巴结的患者。并且可能是由于阶段迁移、治疗、社会或临床特征的混杂。确定的因素负责的影响，可能代表了一个机会，以提高护理质量的结肠癌患者的淋巴结计数增加。建立考克斯比例风险模型，分析来自监测、流行病学和最终结果（SEER）-医疗保险数据库的11,399例I-III期结肠癌患者的生存率。主要预测变量是识别的淋巴结数量。模特允许。调整患者因素、化疗的使用、外科专业以及外科医生和医院病理学家确定的平均淋巴结数量。确定的淋巴结数量与生存率有关。与少于7个淋巴结的患者相比，7 - 11个淋巴结的患者死亡风险降低13%（风险比[HR]，0.87; 95%置信区间[CI]，0.76-0.99; P = 0.037）。超过12个淋巴结的患者风险降低17%（HR，0.83; 95%CI，0.73-0.95; P = 0.005）。调整选定的患者人口统计学特征、接受化疗、外科专业以及外科医生或医院确定的每个标本的平均淋巴结数量并没有显著改变淋巴结数量与生存率之间的关系。这些研究结果反对理解或混淆作为在识别出较少淋巴结的患者中观察到的较差生存率的解释。增加结肠癌标本中识别出的淋巴结数量的国家举措可能不会显著改善癌症特异性结局。（Surgery 2010;147：358-65.）
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 nodes and survival.Conclusion. These findings argue against understanding 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. (Surgery 2010;147:358-65.)