Bilimoria Karl Y, Stewart Andrew K, Palis Bryan E, Bentrem David J, Talamonti Mark S, Ko Clifford Y
Department of Surgery, Feinberg School of Medicine, Northwestern University Chicago, IL 60611, USA.
J Am Coll Surg. 2008 Feb;206(2):247-54. doi: 10.1016/j.jamcollsurg.2007.07.044. Epub 2007 Oct 29.
Studies have demonstrated improved survival when 12 or more nodes are examined for colon cancer. The elderly comprise a major proportion of patients with colon cancer, but it is unknown if examination of 12 or more nodes is appropriate for older patients. Our objective was to assess differences in lymph node evaluation by age and to determine whether adequate nodal evaluation (12 or more nodes) is associated with improved survival in the elderly.
From the National Cancer Data Base (1998 to 2004), we identified 142,009 N0M0 patients who underwent colectomy for adenocarcinoma. Logistic regression was used to determine whether age is associated with adequate nodal examination. Multivariable modeling stratified by age was used to determine whether evaluation of 12 or more nodes is associated with improved survival.
The median number of nodes examined was similar with increasing age (less than 67 years: 11 nodes; 67 to 78 years: 10 nodes; greater than 78 years: 10 nodes). Patients older than 78 years underwent evaluation of 12 or more nodes less frequently than patients less than 67 years old: 47.7% versus 41.4% (p < 0.0001). When adjusted for patient, tumor, treatment, and hospital characteristics, patients greater than 78 years were less likely to have 12 or more nodes examined (odds ratio 0.68, 95% CI 0.65 to 0.70, p < 0.0001). Regardless of age, patients who had 12 or more nodes examined had better survival than those with less than 12 nodes examined (p < 0.0001).
The elderly account for nearly half of patients with colon cancer. Older patients undergo inadequate lymph node evaluation more frequently than younger patients do. Improving lymph node evaluation will result in more accurate pathologic staging for the elderly.
研究表明，结肠癌检查12个或更多淋巴结时患者生存率会提高。老年人占结肠癌患者的很大比例，但对于老年患者检查12个或更多淋巴结是否合适尚不清楚。我们的目的是评估按年龄划分的淋巴结评估差异，并确定充分的淋巴结评估（12个或更多淋巴结）是否与老年人生存率提高相关。
从国家癌症数据库（1998年至2004年）中，我们识别出142,009例接受腺癌结肠切除术的N0M0患者。采用逻辑回归确定年龄是否与充分的淋巴结检查相关。采用按年龄分层的多变量模型确定检查12个或更多淋巴结是否与生存率提高相关。
随着年龄增长，检查的淋巴结中位数相似（小于67岁：11个淋巴结；67至78岁：10个淋巴结；大于78岁：10个淋巴结）。大于78岁的患者检查12个或更多淋巴结的频率低于小于67岁的患者：47.7%对41.4%（p<0.0001）。在对患者、肿瘤、治疗和医院特征进行调整后，大于78岁的患者检查12个或更多淋巴结的可能性较小（优势比0.68，95%CI 0.65至0.70，p<0.0001）。无论年龄如何，检查12个或更多淋巴结的患者比检查少于12个淋巴结的患者生存率更高（p<0.0001）。
老年人占结肠癌患者近一半。老年患者比年轻患者更常接受不充分的淋巴结评估。改善淋巴结评估将使老年人的病理分期更准确。
