Lymph node evaluation linked to improved survival for colon cancer patients

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December 2, 2007

The number of lymph nodes removed and examined for tumor cells appears to be associated with the likelihood of survival after surgery in colon cancer patients, according to a study in the March 21 Journal of the National Cancer Institute. Health care providers should consider the number of lymph nodes that were removed and evaluated when examining the quality of care that colon cancer patients receive, according to the paper’s authors.

Lymph node evaluation is important for determining the prognosis and future treatment of patients with colon cancer because the greater the number of lymph nodes that contain cancer cells, the more likely it is that the cancer will return. But most patients do not get an adequate number of lymph nodes tested. Some experts currently recommend that at least 12 lymph nodes be examined.

George Chang, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues reviewed studies in four major medical databases to see if there was evidence for an association between lymph node evaluation and survival rates for colon cancer patients. They looked at 17 studies from nine countries. Sixteen of the studies found that an increased number of lymph nodes evaluated was associated with improved survival rates for patients with stage II colon cancer. Four of the six studies that included patients with stage III colon cancer had similar findings.

“Recent reports have found that few patients in the United States, Canada, France, The Netherlands, or Sweden are undergoing an adequate lymph node evaluation,”Â the authors write. “Given the results in our systematic review, efforts to improve lymph node evaluation should result in clinically significant improvements in outcome and also the quality of care for patients with colon cancer.”Â

In an accompanying editorial, Rocco Ricciardi, M.D., of Tufts University and the Lahey Clinic in Boston, and Nancy Baxter, M.D., of the University of Toronto, call attention to the many questions that must be addressed before any quality of care standards are put into place. “Simple solutions for quality improvement (such as setting quality benchmarks for [the] number of lymph nodes evaluated in colon cancer) are attractive to policy makers and payers,”Â the authors write. “However, if such solutions are not based on sound evidence, they are likely to fail to achieve improvements in patient outcomes and, worse, may divert attention from effective strategies.-Journal of the National Cancer Institute

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