Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
J Am Coll Surg. 2012 Sep;215(3):400-11. doi: 10.1016/j.jamcollsurg.2012.05.014. Epub 2012 Jun 8.
Among surgically treated patients with colon cancer, lower long-term mortality has been demonstrated in those with 12 or more lymph nodes evaluated. We examined whether patients receiving adequate lymph node evaluation were also more likely to receive comprehensive postsurgical care, leading to lower mortality.
We used the 1992 to 2007 Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify surgically treated American Joint Committee on Cancer (AJCC) stage III colon cancer patients. We used chi-square analyses and logistic regression to evaluate the association between adequate (≥12) lymph node evaluation and receipt of postsurgical care (adjuvant chemotherapy, surveillance colonoscopy, CT scans, and CEA testing) and Cox proportional hazards regression to evaluate 10-year all-cause mortality, adjusting for postsurgical care.
Among 17,906 surgically treated stage III colon cancer patients, adequate (≥12) lymph node evaluation was not associated with receiving comprehensive postsurgical care after adjustment for patient and tumor characteristics (p > 0.05 for all). Initially, adequate lymph node evaluation was associated with lower all-cause mortality (hazard ratio [HR] 0.88; 95% CI [0.85 to 0.91]), but among 3-year survivors, the impact of adequate lymph node evaluation on lower mortality was diminished (HR 0.94; 95% CI [0.88 to 1.01]). However, receiving comprehensive postsurgical care was associated with continued lower mortality in 3-year survivors.
Adequate lymph node evaluation for colon cancer was associated with lower mortality among all patients. However, among 3-year survivors, the association between lymph node evaluation and lower hazard of death was no longer significant, while postsurgical care remained strongly associated with lower long-term mortality, indicating that postsurgical care may partially explain the relationship between lymph node evaluation and mortality.
在接受手术治疗的结肠癌患者中，评估的淋巴结数量达到 12 个或以上的患者其长期死亡率较低。我们研究了接受充分淋巴结评估的患者是否也更有可能接受全面的术后护理，从而降低死亡率。
我们使用了 1992 年至 2007 年的监测、流行病学和最终结果（SEER）-医疗保险数据，以确定接受手术治疗的美国癌症联合委员会（AJCC）分期 III 期结肠癌患者。我们使用卡方分析和逻辑回归来评估充分（≥12 个）淋巴结评估与接受术后护理（辅助化疗、监测结肠镜检查、CT 扫描和 CEA 检测）之间的关联，并使用 Cox 比例风险回归来评估 10 年全因死亡率，调整术后护理因素。
在 17906 例接受手术治疗的 III 期结肠癌患者中，在调整了患者和肿瘤特征后，充分（≥12 个）淋巴结评估与接受全面的术后护理之间没有关联（所有比较的 p 值均>0.05）。最初，充分的淋巴结评估与全因死亡率降低相关（风险比[HR]0.88；95%CI[0.85 至 0.91]），但在 3 年幸存者中，充分的淋巴结评估对降低死亡率的影响减弱（HR 0.94；95%CI[0.88 至 1.01]）。然而，在 3 年幸存者中，接受全面的术后护理与持续降低的死亡率相关。
充分的淋巴结评估与所有患者的死亡率降低相关。然而，在 3 年幸存者中，淋巴结评估与死亡风险降低之间的关联不再显著，而术后护理仍然与长期死亡率降低密切相关，这表明术后护理可能部分解释了淋巴结评估与死亡率之间的关系。
