Identification of 12 or More Lymph Nodes in Resected Colon Cancer Specimens as an Indicator of Quality Performance
Identification of 12 or More Lymph Nodes in Resected Colon Cancer Specimens as an Indicator of Quality Performance
复制标题
DOI：
10.1002/cncr.24185
复制
发表时间：
2009-05-01
期刊：
影响因子：
6.2
通讯作者：
McClure, Stephanie E.
中科院分区：
文献类型：
--
作者：
Dillman, Robert O.;Aaron, Kenneth;McClure, Stephanie E.
背景：在切除的结肠癌标本中鉴定 >= 12 个淋巴结已被认可为质量指标。方法：Hoag 医院癌症登记处用于识别诊断患有结肠癌的患者。结肠癌标本中发现>= 12个淋巴结的比例由解剖位置、疾病阶段、患者年龄和手术外科医生决定。生存率与分期以及是否发现≥12个淋巴结相关。结果：1998 年病理学程序的变化与发现的淋巴结平均数量从 8.0 个增加到 14.5 个相关（P < .0001）；因此，分析仅限于 1998 年至 2005 年间接受结肠腺癌手术切除的 574 名患者。≥ 12 个淋巴结的识别率因 7 个解剖位置而异，从 57% 至 83% 不等（P < .0001），因 5 个年龄组而异于 65% 至 75%（P = .027），因 4 个一般疾病阶段而异于 59% 至 73% (P = .004)，在进行了至少 17 次切除的 12 名外科医生中，这一比例从 53% 上升到 80% (P = .014)。与其他 9 名外科医生相比，3 名接受过结直肠专科培训的外科医生发现 >= 12 个淋巴结的切除比例更高（77% vs 63%，P = .0007），并且 30 名外科医生每人执行 = 12 个淋巴结，与 I 期 (P = .016) 和 II 期 (P = .021) 疾病患者的更好生存相关。结论：解剖位置、结直肠手术训练和病例数量与发现的淋巴结数量密切相关。癌症 2009；115：1840-8。 (C) 2009 年美国癌症协会。
BACKGROUND: Identification of >= 12 lymph nodes in resected colon cancer specimens has been endorsed as a quality indicator. METHODS: The Hoag Hospital cancer registry was used to identify patients diagnosed with colon cancer. The proportion of colon cancer specimens for which >= 12 lymph nodes were identified was determined by anatomic location, stage of disease, patient age, and operating surgeon. Survival was correlated with stage and with whether >= 12 lymph nodes were identified. RESULTS: Pathology procedural changes in 1998 were associated with an increase in the average number of lymph nodes identified from 8.0 to 14.5 (P < .0001); therefore, analysis was limited to 574 patients who underwent surgical resection of colon adenocarcinoma during 1998 to 2005. Identification of >= 12 lymph nodes varied from 57% to 83% by 7 anatomic locations (P < .0001), from 65% to 75% by 5 age cohorts (P = .027), from 59% to 73% by 4 general stages of disease (P = .004), and from 53% to 80% among 12 surgeons who performed at least 17 resections (P = .014). The proportion of resections in which >= 12 lymph nodes were identified was higher for 3 colorectal fellowship-trained surgeons compared with the other 9 surgeons (77% vs 63%, P = .0007), and with 30 surgeons who each performed = 12 lymph nodes was associated with better survival for patients with stage I (P = .016) and stage II (P = .021) disease. CONCLUSIONS: Anatomic location, colorectal surgical training, and case volume were strongly correlated with the number of lymph nodes identified. Cancer 2009;115:1840-8. (C) 2009 American Cancer Society.