TY - JOUR
T1 - Time-dependent trends in lymph node yield and impact on adjuvant therapy decisions in colon cancer surgery
T2 - An international multi-institutional study
AU - Stojadinovic, Alexander
AU - Nissan, Aviram
AU - Wainberg, Zev
AU - Shen, Perry
AU - McCarter, Martin
AU - Protic, Mladjan
AU - Howard, Robin S.
AU - Steele, Scott R.
AU - Peoples, George E.
AU - Bilchik, Anton
N1 - Funding Information:
FUNDING Supported by the United States Military Cancer Institute and Grant 2RO1CA090848-05A2 from the National Cancer Institute and the California Oncology Research Institute (CORI), the Joyce E and Ben B Eisenberg Foundation, the Hearst Foundation, the Davidow Charitable Fund, the Rod Fasone Memorial Cancer Fund, Mrs. Ruth Weil, the Sequoia Foundation for achievement in the arts and education, and Mrs. Marguerite Perkins Mautner.
PY - 2012/12
Y1 - 2012/12
N2 - Background. Lymph node yield (LNY) and accuracy of nodal assessment are critical to staging and treatment planning in colon cancer (CC). A nationally agreed upon 12-node minimum is a quality standard in CC. The impact of this quality measure onLNY and impact on therapeutic decisions are evaluated in two international, multi-center, prospective trials comprising a well-characterized cohort assembled over 8 years (2001-2009) with long-term follow-up. Hypothesis. Quality adherence through increased LNY improves staging accuracy and impacts adjuvant therapy decisions. Methods. Retrospective analysis of prospective data to assess time-dependent LNY, the dependent variable in multivariate linear regression analysis adjusted for age, gender, body-mass-index (BMI), tumor size/stage/grade, anatomic location and surgery date. Results. Two-hundred-forty-five patients with non-meta-static CC, median age 70 years, BMI 26 kg/m2, tumor size 4.0 cm, and LNY 17 nodes were studied. Seventy-two percent had T3 (70 %)/T4 (2 %) tumors. Adherence to the 12-node minimum was 70 %(2001-2002), 81 % (2003-2004), 90 % (2005-2006), 94 % (2007-2008). LNY significantly increased over time (Median LNY: 2001- 2004 = 15 vs. 2005-2008 = 17; P<0.001) on multivari-ate analysis controlling for tumor size (P < 0.001), and right-sided tumor location (P< 0.001). Adjuvant therapy administration and indication for chemotherapy according to LNY (<12 vs. 12 ? LNs = 33 % vs. 39 %; P = 0.48) and time period (2001-2004 vs. 2005-2008 = 39 % vs. 37 %; P = 0.89) remained unchanged. Conclusions. Despite the independent predictors of nodal yield (tumor location and size), year of study still had a significant impact on nodal yield. Despite increased quality adherence and LNY over time, there appears to be a delayed impact on adjuvant therapy decisions once quality standard adherence takes effect.
AB - Background. Lymph node yield (LNY) and accuracy of nodal assessment are critical to staging and treatment planning in colon cancer (CC). A nationally agreed upon 12-node minimum is a quality standard in CC. The impact of this quality measure onLNY and impact on therapeutic decisions are evaluated in two international, multi-center, prospective trials comprising a well-characterized cohort assembled over 8 years (2001-2009) with long-term follow-up. Hypothesis. Quality adherence through increased LNY improves staging accuracy and impacts adjuvant therapy decisions. Methods. Retrospective analysis of prospective data to assess time-dependent LNY, the dependent variable in multivariate linear regression analysis adjusted for age, gender, body-mass-index (BMI), tumor size/stage/grade, anatomic location and surgery date. Results. Two-hundred-forty-five patients with non-meta-static CC, median age 70 years, BMI 26 kg/m2, tumor size 4.0 cm, and LNY 17 nodes were studied. Seventy-two percent had T3 (70 %)/T4 (2 %) tumors. Adherence to the 12-node minimum was 70 %(2001-2002), 81 % (2003-2004), 90 % (2005-2006), 94 % (2007-2008). LNY significantly increased over time (Median LNY: 2001- 2004 = 15 vs. 2005-2008 = 17; P<0.001) on multivari-ate analysis controlling for tumor size (P < 0.001), and right-sided tumor location (P< 0.001). Adjuvant therapy administration and indication for chemotherapy according to LNY (<12 vs. 12 ? LNs = 33 % vs. 39 %; P = 0.48) and time period (2001-2004 vs. 2005-2008 = 39 % vs. 37 %; P = 0.89) remained unchanged. Conclusions. Despite the independent predictors of nodal yield (tumor location and size), year of study still had a significant impact on nodal yield. Despite increased quality adherence and LNY over time, there appears to be a delayed impact on adjuvant therapy decisions once quality standard adherence takes effect.
UR - http://www.scopus.com/inward/record.url?scp=84876480366&partnerID=8YFLogxK
U2 - 10.1245/s10434-012-2501-5
DO - 10.1245/s10434-012-2501-5
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C2 - 22805869
AN - SCOPUS:84876480366
SN - 1068-9265
VL - 19
SP - 4178
EP - 4185
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 13
ER -
