Examining a specific number of lymph nodes after colon cancer surgery, a measurement that has been recommended as a quality indicator for hospitals, is not associated with length of patient survival, according to a study in the November 14 issue of JAMA.
Several studies have suggested improved survival among patients in whom a higher number of nodes are examined after colectomy for colon cancer (part or all of the colon is removed). Several organizations recently endorsed a 12-node minimum as a standard for hospital-based performance, according to background information in the article. Large private payers have already begun incorporating this measure into their pay-for-performance programs. Whether such efforts will improve outcomes for patients with colon cancer remains unclear, as is whether node counts are useful as an indicator of hospital quality.
Sandra L. Wong, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues, using data from the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1995-2005), assessed whether hospitals lymph node examination rates were associated with cancer staging, use of adjuvant (supplemental) chemotherapy (indicated for patients with node-positive disease), and 5-year survival. The study included 30,625 patients undergoing colectomy for nonmetastatic colon cancer. Hospitals were ranked according to the proportion of their patients in whom 12 or more lymph nodes were examined and then were sorted into four groups. Late survival rates were assessed for each hospital group, adjusting for potentially confounding patient and clinician characteristics.
Hospitals with the highest proportions of patients with 12 or more lymph nodes examined tended to treat lower-risk patients and had substantially higher procedure volumes. After adjusting for these and other factors, there remained no statistically significant relationship between hospital lymph node examinatio
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