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Ethnicity Influences Lymph Node Resection in Colon Cancer

  • 2010 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

The purpose of this study is to determine the association between ethnicity and lymph node retrieval after colon cancer resection. Using the Surveillance Epidemiology and End Results (SEER)–Medicare database, patients who underwent colon cancer resection from 2000–2003 were evaluated. Subjects were classified as having <12 (N = 20,605) or ≥12 (N = 12,358) lymph nodes examined. Multivariate models were used to analyze the relationship between lymph nodes resected and independent variables. Out of a total of 32,936 patients, 62.5% had fewer than 12 lymph nodes resected. In multivariate analysis, Hispanic ethnicity was associated with a significantly lower chance of having ≥12 lymph nodes than the Caucasian population (OR = 0.61; CI, 0.50–0.74). Despite this, there was no understaging: the proportion of stage II and III diagnoses was the same. Both groups received the same rate of cancer-directed surgery and survival was equivalent. During this study period, a majority of colon cancer resections were inadequate based on the current standard of ≥12 nodes. Hispanic patients were less likely to have an adequate node resection when compared to Caucasians. Despite fewer lymph nodes harvested, they had equivalent staging and survival. These results suggest that ethnicity influences the lymph node count.

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References

  1. National Quality Forum. NQF-Endorsed Standards on lymph nodes examined for colon cancer resection (http://www.qualityforum.org/Measures_List.aspx#k=lymph%2520node&e=1&st=&sd=&s=&p=1). 2010.

  2. Bilimoria KY, Bentrem DJ, Stewart AK, Talamonti MS, Winchester DP, Russell TR and Ko CY. Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst 100: 18: 1310–1317, 2008.

    Article  PubMed  Google Scholar 

  3. Kukreja SS, Esteban-Agusti E, Velasco JM and Hieken TJ. Increased lymph node evaluation with colorectal cancer resection: does it improve detection of stage III disease? Arch Surg 144: 7: 612–617, 2009.

    Article  PubMed  Google Scholar 

  4. Chang GJ, Rodriguez-Bigas MA, Skibber JM and Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review.[see comment]. J Natl Cancer Inst 99: 6: 433–441, 2007.

    Article  PubMed  Google Scholar 

  5. Wong SL, Ji H, Hollenbeck BK, Morris AM, Baser O and Birkmeyer JD. Hospital lymph node examination rates and survival after resection for colon cancer. JAMA 298: 18: 2149–2154, 2007.

    Article  CAS  PubMed  Google Scholar 

  6. Wong SL. Lymph node counts and survival rates after resection for colon and rectal cancer. Gastrointest Cancer Res 3: 2 Suppl: S33–5, 2009.

    PubMed  Google Scholar 

  7. Swanson RS, Compton CC, Stewart AK and Bland KI. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Onc 10: 1: 65–71, 2003.

    Article  Google Scholar 

  8. Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J and Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97: 3: 219–225, 2005.

    Article  PubMed  Google Scholar 

  9. Tekkis PP, Smith JJ, Heriot AG, Darzi AW, Thompson MR, Stamatakis JD and Association of Coloproctology of Great Britain and,Ireland. A national study on lymph node retrieval in resectional surgery for colorectal cancer. Dis Colon Rectum 49: 11: 1673–1683, 2006.

    Article  PubMed  Google Scholar 

  10. Bilimoria KY, Stewart AK, Palis BE, Bentrem DJ, Talamonti MS and Ko CY. Adequacy and importance of lymph node evaluation for colon cancer in the elderly. J Am Coll Surg 206: 2: 247–254, 2008.

    Article  PubMed  Google Scholar 

  11. Gorog D, Nagy P, Peter A and Perner F. Influence of obesity on lymph node recovery from rectal resection specimens. Path Onc Research 9: 3: 180–183, 2003.

    Article  Google Scholar 

  12. Dignam JJ, Colangelo L, Tian W, Jones J, Smith R, Wickerham DL and Wolmark N. Outcomes among African-Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. J Natl Cancer Inst 91: 22: 1933–1940, 1999.

    Article  CAS  PubMed  Google Scholar 

  13. Shavers VL. Racial/ethnic variation in the anatomic subsite location of in situ and invasive cancers of the colon. J Natl Med Assoc 99: 7: 733–748, 2007.

    PubMed  Google Scholar 

  14. National Cancer Institute. Surveillance, epidemiology and end results cancer registry [Online]. http://seer.cancer.gov.

  15. Baxter NN, Ricciardi R, Simunovic M, Urbach DR and Virnig BA. An evaluation of the relationship between lymph node number and staging in pT3 colon cancer using population-based data. Dis Colon Rectum 53: 1: 65–70, 2010.

    PubMed  Google Scholar 

  16. Gavrilov L and Heuveline P. Aging of Population. In: The Encyclopedia of Population. New York, USA: MacMillan Reference, 2003.

  17. American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2009–2011 [Online]. http://www.cancer.org/downloads/STT/FF_Hispanics_Latinos_2009_2011.pdf [April, 2010].

  18. Corbie-Smitha G, St. George D, Moody-Ayers S and Ransohoff D. Adequacy of reporting race/ethnicity in clinical trials in areas of health disparities. J Clin Epi 56: 5: 416–420, 2003.

  19. Bathe OF, Caldera H, Hamilton-Nelson K, Franceschi D, Sleeman D, Levi JU and Livingstone AS. Influence of Hispanic ethnicity on outcome after resection of carcinoma of the head of the pancreas. Cancer 91: 6: 1177–1184, 2001.

    Article  CAS  PubMed  Google Scholar 

  20. Du XL, Meyer TE and Franzini L. Meta-analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer. Cancer 109: 11: 2161–2170, 2007.

    Article  PubMed  Google Scholar 

  21. Chen SL and Bilchik AJ. More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg 244: 4: 602–610, 2006.

    PubMed  Google Scholar 

  22. Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 26: 2: 179–189, 2002.

    Article  PubMed  Google Scholar 

  23. Murphy J, Pocard M, Jass JR, O’Sullivan GC, Lee G and Talbot IC. Number and size of lymph nodes recovered from dukes B rectal cancers: correlation with prognosis and histologic antitumor immune response. Dis Colon Rectum 50: 10: 1526–1534, 2007.

    Article  PubMed  Google Scholar 

  24. Jakub JW, Russell G, Tillman CL and Lariscy C. Colon cancer and low lymph node count: who is to blame? Arch Surg 144: 12: 1115–1120, 2009.

    Article  PubMed  Google Scholar 

  25. Bilimoria KY, Palis B, Stewart AK, Bentrem DJ, Freel AC, Sigurdson ER, Talamonti MS and Ko CY. Impact of tumor location on nodal evaluation for colon cancer. Dis Colon Rectum 51: 2: 154–161, 2008.

    Article  PubMed  Google Scholar 

  26. Wong JH, Severino R, Honnebier MB, Tom P and Namiki TS. Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17: 9: 2896–2900, 1999.

    CAS  PubMed  Google Scholar 

  27. Joseph NE, Sigurdson ER, Hanlon AL, Wang H, Mayer RJ, MacDonald JS, Catalano PJ and Haller DG. Accuracy of determining nodal negativity in colorectal cancer on the basis of the number of nodes retrieved on resection. Ann Surg Onc 10: 3: 213–218, 2003.

    Article  Google Scholar 

  28. Gomez D, Dalal Z, Raw E, Roberts C and Lyndon PJ. Anatomical distribution of colorectal cancer over a 10 year period in a district general hospital: is there a true “rightward shift”? Postgrad Med J 80: 949: 667–669, 2004.

    Article  CAS  PubMed  Google Scholar 

  29. Chattar-Cora D, Onime GD, Coppa GF, Valentine IS and Rivera L. Anatomic, age, and sex distribution of colorectal cancer in a New York City Hispanic population. J Natl Med Assoc 90: 1: 19–24, 1998.

    CAS  PubMed  Google Scholar 

  30. Vaccaro CA, Im V, Rossi GL, Quintana GO, Benati ML, Perez de Arenaza D and Bonadeo FA. Lymph node ratio as prognosis factor for colon cancer treated by colorectal surgeons. Dis Colon Rectum 52: 7: 1244–1250, 2009.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L223, Portland, OR , 97239, USA

    Molly M. Cone, Jennifer D. Rea, Kim C. Lu & Daniel O. Herzig

  2. Graduate Medical Education, MPH Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR , 97239, USA

    Kelsea M. Shoop

Authors
  1. Molly M. Cone
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  2. Kelsea M. Shoop
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  3. Jennifer D. Rea
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Correspondence to Daniel O. Herzig.

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Cone, M.M., Shoop, K.M., Rea, J.D. et al. Ethnicity Influences Lymph Node Resection in Colon Cancer. J Gastrointest Surg 14, 1752–1757 (2010). https://doi.org/10.1007/s11605-010-1296-6

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  • DOI: https://doi.org/10.1007/s11605-010-1296-6

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