Lymph Node Evaluation as a Colon Cancer Quality Measure: A National Hospital Report Card
| Autor: | David P. Winchester, Clifford Y. Ko, David J. Bentrem, Andrew K. Stewart, Thomas R Russell, Mark S. Talamonti, Karl Y. Bilimoria |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Oncology Cancer Research medicine.medical_specialty Colorectal cancer medicine.medical_treatment Population Internal medicine Humans Medicine education Lymph node Colectomy Aged education.field_of_study business.industry Cancer Cancer Care Facilities Articles Middle Aged medicine.disease Hospitals United States Surgery Benchmarking Logistic Models medicine.anatomical_structure Lymphatic Metastasis Localized disease Colonic Neoplasms Multivariate Analysis Female Guideline Adherence Lymph Nodes Lymph business |
| Zdroj: | JNCI: Journal of the National Cancer Institute. 100:1310-1317 |
| ISSN: | 1460-2105 0027-8874 |
| DOI: | 10.1093/jnci/djn293 |
| Popis: | Colon cancer is the most common gastrointestinal malignancy and the second-leading cause of cancer death in the United States ( 1 ). Approximately 80% of colon cancer patients present with resect-able, localized disease, and in these patients, nodal metastases have long been recognized as the most important factor predicting long-term survival ( 1 , 2 ). Nodal involvement is an important deter-minant in the decision to administer adjuvant chemotherapy, and with the demonstration over the last decade of highly effective systemic therapies for colon cancer, it is essential to ensure that all patients who would benefit from such treatment receive counsel-ing concerning these therapies and have access to them ( 3 ). Numerous studies have shown an improvement in disease-specifi c and overall survival when increasing numbers of lymph nodes are examined for colon cancer ( 4 – 13 ). The improvement in outcomes is probably due in part to stage migration or more accu-rate staging that allows for increased utilization of adjuvant che-motherapy. The adequacy of lymph node examination for colon cancer may alternatively be a proxy for other factors that account for the improvement in outcomes, such as overall surgical tech-nique and cancer surveillance activities ( 14 ). The suggestion that there is a direct therapeutic benefi t from a more complete lymph-adenectomy is controversial ( 14 ). There has been a considerable effort to determine the minimum number of nodes that need to be evaluated to deem a patient free of nodal metastases with reasonable certainty. Estimates have varied from 6 to 40 lymph nodes ( 5 , 9 , 11 – 15 ); however, numerous studies and consensus guidelines have suggested that examination of 12 regional lymph nodes is a reasonable minimum for adequate nodal evaluation for colon cancer ( 5 , 9 , 11 – 20 ). Despite these fi ndings, population-based assessments have shown that the majority of patients in the United States do not have 12 or more nodes examined ( 21 , 22 ). |
| Databáze: | OpenAIRE |
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