Lemmens V E, van Lijnschoten I, Janssen-Heijnen M L, Rutten H J, Verheij C D, Coebergh J-W W
Department of Research, Comprehensive Cancer Centre South, Eindhoven, USA.
Ann Oncol. 2006 Dec;17(12):1803-9. doi: 10.1093/annonc/mdl312. Epub 2006 Sep 13.
A large variation in the number of nodes examined between patients, hospitals, and regions has been reported for patients with colon cancer. We studied determinants of this variation and its relation to survival in the south of The Netherlands.
All patients who underwent resection for stage I-III colon carcinoma diagnosed from 1999 to 2002 in the Eindhoven Cancer Registry area were included (n = 2168). Determinants of lymph node evaluation and their relationship to survival were assessed, including variation between the six departments of pathology.
A median number of six lymph nodes per specimen had been examined. The median number for each department of pathology ranged from three to eight (P < 0.0001). After correction for relevant factors, this variation remained, resulting in differences in the proportion of N+ tumours between departments from 29% to 41% (P < 0.0001). The number of nodes examined was positively associated with survival. Survival for node-negative patients differed between the departments of pathology (up to hazard ratio 1.5; P = 0.02).
There was a large variation in lymph node evaluation between the departments of pathology, leading to differences in stage distribution and survival. Intervention strategies should be directed at nodal assessment.
据报道，结肠癌患者在患者之间、医院之间以及地区之间检查的淋巴结数量存在很大差异。我们研究了荷兰南部这种差异的决定因素及其与生存率的关系。
纳入1999年至2002年在埃因霍温癌症登记区接受I-III期结肠癌切除术的所有患者（n = 2168）。评估了淋巴结评估的决定因素及其与生存率的关系，包括六个病理科之间的差异。
每个标本检查的淋巴结中位数为6个。每个病理科的中位数范围为3至8个（P < 0.0001）。在对相关因素进行校正后，这种差异仍然存在，导致各科室N+肿瘤的比例在29%至41%之间存在差异（P < 0.0001）。检查的淋巴结数量与生存率呈正相关。病理科之间淋巴结阴性患者的生存率存在差异（最高风险比为1.5；P = 0.02）。
各病理科之间的淋巴结评估存在很大差异，导致分期分布和生存率存在差异。干预策略应针对淋巴结评估。
