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Lymph node evaluation in colorectal cancer patients: a population-based study
Nancy N Baxter1, Dan J Virnig, David A Rothenberger
1Division of Surgical Oncology, Department of Surgery, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA. baxte025@umn.edu
Journal of the National Cancer Institute
|February 3, 2005
Summary
Most colorectal cancer patients still lack adequate lymph node evaluation, with only 37% meeting the 12-node guideline. Factors like patient age and geographic location influence evaluation adequacy, highlighting practice pattern variations.
Area of Science:
- Oncology
- Surgical Pathology
- Cancer Staging
Background:
- Adequate lymph node evaluation is crucial for accurate colorectal cancer staging and patient survival.
- Current guidelines recommend examining a minimum of 12 lymph nodes for adequate colorectal cancer sampling.
- The Surveillance, Epidemiology, and End Results (SEER) program provides data to assess lymph node evaluation rates in the US.
Purpose of the Study:
- To determine the proportion of colorectal cancer patients in the United States receiving adequate lymph node evaluation.
- To identify patient and tumor factors associated with adequate lymph node evaluation.
- To analyze trends in lymph node evaluation over time.
Main Methods:
- Analysis of 116,995 adult colorectal adenocarcinoma cases diagnosed between 1988 and 2001 from the SEER program.
- Inclusion criteria: radical surgery, no neoadjuvant radiation.
- Evaluation of lymph node count, likelihood of meeting the 12-node threshold, and influencing factors.
Main Results:
- Median lymph nodes examined was nine; only 37% of patients had adequate evaluation (≥12 nodes).
- Adequate evaluation increased from 32% (1988) to 44% (2001).
- Advanced tumor stage, younger age, right-sided tumors, and geographic location were associated with higher adequacy rates.
Conclusions:
- The majority of colorectal cancer patients received inadequate lymph node evaluation in 2001.
- Patient demographics (age, location) correlate with evaluation adequacy, suggesting variations in surgical and pathology practices.
- Improving lymph node evaluation remains critical for optimal colorectal cancer management.