Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
Cancer Epidemiol Biomarkers Prev. 2010 Mar;19(3):738-45. doi: 10.1158/1055-9965.EPI-09-1086. Epub 2010 Mar 3.
The pathologic identification of 12 or more lymph nodes (LN) after colectomy for colon cancer became a quality indicator for surgery in 2001. We investigated whether this new standard of care was differentially adopted across racial and socioeconomic lines.
We identified 111,339 stage I to III colon cancer patients identified as black or white in the Surveillance, Epidemiology, and End Results database from 1988 to 2004 who underwent colectomy. We did multivariable logistic regression to investigate the influence of race, area socioeconomic status (SES), and other clinical and demographic characteristics on the number of LNs examined.
Between 1988 and 2004, white patients were more likely than black patients to have > or =12 LNs identified (odds ratio, 1.06; 95% confidence interval, 1.02-1.10) after adjustment for age, year of diagnosis, sex, marital status, tumor grade, stage, and subsite within the colon. After adjustment for SES, race was no longer significant (adjusted odds ratio, 1.00; 95% confidence interval, 0.96-1.04). There was, however, a significant positive trend between a patient's SES and having > or =12 LNs examined (P(trend) < 0.0001), with a 30% increased odds comparing the highest to the lowest quintiles of SES. We found that the association between SES and the dissection of > or =12 LNs was only present in individuals diagnosed after 1999.
The association between high SES and the examination of > or =12 LNs was only apparent from 2000 onward, and coincides with its dissemination and acceptance as a new standard of care. This suggests that the emergence of LN dissection as a quality indicator may have been more rapidly disseminated into higher SES groups.
2001 年，结肠癌手术后切除 12 个或更多淋巴结（LN）成为手术质量指标。我们研究了这种新的护理标准是否在种族和社会经济线之间存在差异。
我们从 1988 年至 2004 年的监测、流行病学和最终结果数据库中确定了 111339 名 I 期至 III 期结肠癌患者，这些患者被确定为黑人和白人，并接受了结肠切除术。我们进行了多变量逻辑回归分析，以研究种族、地区社会经济状况（SES）以及其他临床和人口统计学特征对检查的淋巴结数量的影响。
在 1988 年至 2004 年期间，白人患者比黑人患者更有可能在调整年龄、诊断年份、性别、婚姻状况、肿瘤分级、分期和结肠内肿瘤部位后，识别出 >或=12 个 LN（优势比，1.06；95%置信区间，1.02-1.10）。在调整 SES 后，种族不再具有统计学意义（调整后的优势比，1.00；95%置信区间，0.96-1.04）。然而，患者 SES 与检查 >或=12 个 LN 之间存在显著的正相关趋势（P（趋势）<0.0001），与 SES 最低五分位相比，最高五分位的优势比增加了 30%。我们发现 SES 与检查 >或=12 个 LN 之间的关联仅存在于 1999 年后诊断的个体中。
SES 与检查 >或=12 个 LN 之间的关联仅在 2000 年以后才出现，并且与 LN 切除作为新的护理标准的传播和接受一致。这表明，作为质量指标的 LN 切除的出现可能更快地传播到 SES 较高的群体中。
