The relation between lymph node status and survival in <scp>S</scp>tage I–<scp>III</scp> colon cancer: results from a prospective nationwide cohort study

Lykke, Jakob; Roikjær, O; Jess, Per

doi:10.1111/codi.12059

Cited by 78 publications

(64 citation statements)

References 28 publications

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“…3 Furthermore, a large prospective trial and several population-based studies reported that an increase in the number of lymph nodes sampled could improve survival through accurate staging and consequently tailored treatments. [4][5][6] A large body of research has documented that shortterm surgical complications and long-term survival are correlated with hospital volume. [7][8][9] Surgery-related mortality can be avoided if cancer surgeries are performed by high-volume hospitals.…”

Section: Introductionmentioning

confidence: 99%

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

Liu

Chou²,

Teng

et al. 2015

Cancer

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BACKGROUND:Patients with colorectal cancer (CRC) who undergo cancer surgeries with higher-volume providers may have better outcomes. The current debate focuses on whether it is hospital volume or surgeon volume that matters more. METHODS: The authors conducted a nationwide population-based study in Taiwan that enrolled all patients who underwent definitive surgery for newly diagnosed CRC between 2005 and 2011. All patients were divided into 4 quartiles according to hospital and surgeon volume. The main outcome was the 5-year mortality rate, which was analyzed using a frailty model for Cox regression. The authors also conducted fixed and random effects multivariate regression models to examine short-term outcomes and resource use, including operative mortality, hospital stay, emergency department visits within 30 days, and medical expenses. Analyses were adjusted for patient and provider characteristics. RESULTS: A total of 61,728 patients with CRC were included in the current study. The 5-year mortality rates were 38.7%, 32.8%, 32.0%, and 29.1% in descending order of hospital volume quartiles and were 41.4%, 34.1%, 29.8%, and 27.4% in descending order of surgeon volume quartiles. After adjustment for the individual and provider characteristics, surgeon volume, but not hospital volume, remained a significantly predictive factor of death (P<.001). In addition, those patients with CRC who underwent definitive surgeries performed by higher-volume surgeons had a relatively lower risk of operative mortality, shorter hospital length of stay, and lower medical expenses. CONCLUSIONS: Patients with CRC who underwent definitive surgery performed by higher-volume providers were found to have better outcomes. Surgeon volume may play a more important role than hospital volume. Cancer 2015;121:2782-90.

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Section: Introductionmentioning

confidence: 99%

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

Liu

Chou²,

Teng

et al. 2015

Cancer

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“…Assessment of at least 12 lymph nodes is important for accurate staging and treatment planning and is associated with improved survival 5 . The percentage of breast cancer resections that used breast-conserving surgery rather than mastectomy ranged from 31% to 75% (Figure 6).…”

Section: Resultsmentioning

confidence: 99%

How Different Is Cancer Control across Canada? Comparing Performance Indicators for Prevention, Screening, Diagnosis, and Treatment

et al. 2017

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Meaningful performance measures are an important part of the toolkit for health system improvement. The Canadian Partnership Against Cancer has been reporting on pan-Canadian cancer system performance indicators since 2009-work that has led to the availability of standardized measures that can help to shed light on the extent of variation and opportunities for quality improvement across the country. Those measures include a core set of system indicators ranging from prevention and screening, through diagnosis and treatment, to survivorship and end-of-life care.Key indicators were calculated and graphed, showing the range from worst to best result for the provinces and territories included in the data. There were often significant differences in cancer system performance between provinces and territories. For example, smoking prevalence rates ranged from 14% to 62%. The 90th percentile wait times from an abnormal breast screen to resolution (without biopsy) ranged from 4 weeks to 8 weeks. The percentage of breast cancer resections that used breast-conserving surgery rather than mastectomy ranged from 38% to 75%. Clinical trial participation rates for adults ranged from 0.2% to 6.6%.Variations in performance indicators between Canadian jurisdictions suggest potential differences in the planning and delivery of cancer control services and in clinical practice patterns and patient outcomes. Understanding sources of variation can help to identify opportunities for improvements in the quality and outcomes of cancer control service delivery in each province and territory.

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“…Numerous previous studies [18][19][20][21][22][29][30][31][32]39 have shown an association of a low lymph node count and adverse outcome in colon cancer, particularly in stage II. These studies have sensitized surgeons, oncologists, and pathologists for the importance of adequate lymph node examination.…”

Section: Discussionmentioning

confidence: 99%

Lymph node count and prognosis in colorectal cancer: The influence of examination quality

Bläker

Hildebrandt

Riess

et al. 2014

Intl Journal of Cancer

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Colorectal cancer guidelines recommend adjuvant chemotherapy in stage II disease when less than 12 lymph nodes are assessed. The recommendation bases on previous studies showing an association of a low lymph node count and adverse outcome. Compared to current standards, however, the quality of lymph node examination in the studies was low. We, therefore, investigated the prognostic role of <12 lymph nodes in cancers diagnosed adherent to current quality measures. Stage I-IV colorectal cancers from 1,899 patients enrolled into a population-based cohort study were investigated for the prognostic impact of a lymph node count <12. The stage specific share of patients diagnosed with 12 nodes (stage I-IV: 62, 85, 85, 78%, respectively) was used to compare lymph node examination quality to other studies. We found no impact of a lymph node count <12 on overall, cancer-specific or recurrence-free survival for any tumour stage. Compared to studies reporting an adverse prognostic impact of a low lymph node count in stages II and III the stage-specific shares of patients with 12 nodes were markedly higher in this study (85% vs. 24-58% in previous analyses) and this correlated with increased rates of stage III compared to stage II cancers. In conclusion our data indicate, that the previously reported effect of a low lymph node count on the patients' outcomes is eliminated by improved lymph node examination quality and thus question the general applicability of a 12 lymph node cut off for adjuvant chemotherapy decision making in stage II disease.

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The relation between lymph node status and survival in Stage I–III colon cancer: results from a prospective nationwide cohort study

Abstract: High lymph node count was associated with improved overall survival in colon cancer. Lymph node ratio was superior to N-stage in differentiating overall survival in Stage III colon cancer. Stage migration was observed.

Cited by 78 publications

References 28 publications

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

How Different Is Cancer Control across Canada? Comparing Performance Indicators for Prevention, Screening, Diagnosis, and Treatment

Lymph node count and prognosis in colorectal cancer: The influence of examination quality

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