Display Settings:

Format

Send to:

Choose Destination
We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
JAMA. 2011 Sep 14;306(10):1089-97. doi: 10.1001/jama.2011.1285.

Association between lymph node evaluation for colon cancer and node positivity over the past 20 years.

Author information

  • 1Applied Research Program, National Cancer Institute, Executive Plaza North, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344, USA. helen.parsons@nih.gov

Abstract

CONTEXT:

Among patients surgically treated for colon cancer, better survival has been demonstrated in those with more lymph nodes evaluated. The presumed mechanism behind this association suggests that a more extensive lymph node evaluation reduces the risk of understaging, leading to improved survival.

OBJECTIVE:

To further evaluate the mechanism behind lymph node evaluation and survival by examining the association between more extensive lymph node evaluation, identification of lymph node-positive cancers, and hazard of death.

DESIGN:

Observational cohort study.

SETTING:

Surveillance, Epidemiology, and End Results (SEER) program data from 1988 through 2008.

PATIENTS:

86,394 patients surgically treated for colon cancer.

MAIN OUTCOME MEASURE:

We examined the relationship between lymph node evaluation and node positivity using Cochran-Armitage tests and multivariate logistic regression. The association between lymph node evaluation and hazard of death was evaluated using Cox proportional hazards modeling.

RESULTS:

The number of lymph nodes evaluated increased from 1988 to 2008 but did not result in a significant overall increase in lymph node positivity. During 1988-1990, 34.6% of patients (3875/11,200) had 12 or more lymph nodes evaluated, increasing to 73.6% (9798/13,310) during 2006-2008 (P < .001); however, the proportion of node-positive cancers did not change with time (40% in 1988-1990, 42% in 2006-2008, P = .53). Although patients with high levels of lymph node evaluation were only slightly more likely to be node positive (adjusted odds ratio for 30-39 nodes vs 1-8 nodes, 1.11; 95% CI, 1.02-1.20), these patients experienced significantly lower hazard of death compared with those with fewer nodes evaluated (adjusted hazard ratio for 30-39 nodes vs 1-8 nodes, 0.66; 95% CI, 0.62-0.71; unadjusted 5-year mortality, 35.3%).

CONCLUSION:

The number of lymph nodes evaluated for colon cancer has markedly increased in the past 2 decades but was not associated with an overall shift toward higher-staged cancers, questioning the upstaging mechanism as the primary basis for improved survival in patients with more lymph nodes evaluated.

Comment in

PMID:
21917579
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Write to the Help Desk