539 Background: Lymph node (LN) number has been endorsed as a quality measure (QM) in colon cancer (CC) because of the impact on survival. However, the current mandate requiring > 12 LNs has been questioned. We evaluated whether compliance of this QM has improved and whether this has impacted overall survival (OS). Methods: The Surveillance, Epidemiology, and End Results (SEER) Database was queried to identify patients (pts) with pathologically confirmed, localized and regional CC (Stage I-III) diagnosed between 1988 and 2008. Interval trends in lymph node (LN) harvest and OS were evaluated over time (Year Strata (YS): 1988-1993, 1994-1998, 1999-2003 and 2004-2008). Results: For pts with local and regional CC, 181,035 had confirmed LN examinations. For Stages I-III, there has been a dramatic improvement in compliance for pts with > 12 LNs harvested over the recent two 5-yr periods (19, 21, 18% respectively, p<0.0001) whereas previously only a 5-7% increase occurred over time (see Table ). This rise in compliance had the greatest effect on the increased survival trend for stage II CC with minimal change for those with Stage I and Stage III CC. Irrespective of LN examined there has been a significant increase in OS for all stages over time (p<.0001). Conclusions: In the largest time-dependent assessment of lymph node examination in colon cancer, significant improvements in surgical quality measures have occurred over the past decade for Stage I, II and III. These measures have translated into improvements in overall survival particularly for Stage II disease. Lymph node yield alone is not an adequate quality measure for patients with stage I and III colon cancer. [Table: see text]
Dr Charlton et al., Commentary and Complementary Data to Add to “Compliance with Cancer Quality Measures Over Time and Their Association with Survival Outcomes: The Commission on Cancer’s Experience with the Quality Measure Requiring at Least 12 Regional Lymph Nodes to be Removed and Analyzed with Colon Cancer Resections”
