Fax: (504) 568-5800
Influence of socioeconomic status and hospital type on disparities of lymph node evaluation in colon cancer patients
Article first published online: 31 AUG 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 6, pages 1675–1683, 15 March 2012
How to Cite
Hsieh, M.-C., Velasco, C., Wu, X.-C., Pareti, L. A., Andrews, P. A. and Chen, V. W. (2012), Influence of socioeconomic status and hospital type on disparities of lymph node evaluation in colon cancer patients. Cancer, 118: 1675–1683. doi: 10.1002/cncr.26473
- Issue published online: 2 MAR 2012
- Article first published online: 31 AUG 2011
- Manuscript Accepted: 30 JUN 2011
- Manuscript Revised: 28 JUN 2011
- Manuscript Received: 1 APR 2011
- colon cancer;
- lymph node dissection;
- socioeconomic status;
- hospital type;
A minimum of 12 dissected lymph nodes (LNs) has been recommended as a consensus guideline for resections in colon cancer patients. This study assessed the influence of both socioeconomic status (SES) and hospital type on compliance with this colon LN dissection guideline and examined the time trend for ≥12 LNs dissected.
Stage I to III incident colon cancer cases diagnosed from 1996 to 2007 were obtained from the Louisiana Tumor Registry. A composite census tract-level SES score was created to serve as a surrogate for individual-level SES. Hospitals performing colon resections were categorized into 5 groups according to the Commission on Cancer Accreditation Program. Multiple logistic regression analyses were used.
Of 10,460 colon cancer cases diagnosed during the study period, 43.9% had ≥12 LNs dissected. Patients residing in less affluent SES areas were less likely to receive a dissection of ≥12 nodes than those residing in more affluent areas. SES was no longer significant after adjusting for race, sex, age, stage, grade, anatomic subsite, diagnosis year, and hospital type. In contrast, hospital type was significantly associated with the number of LNs dissected, even after adjusting for other factors. Patients diagnosed from 2002 to 2007 were twice as likely (95% confidence interval, 1.84-2.17) to have ≥12 LNs dissected than those diagnosed from 1996 to 2001 after adjustment.
In Louisiana, hospital type is an independent significant predictor of adequate LN evaluation for colon cancer. Training and education are needed to reduce this disparity in the facilities with consistently lower LN yield in their dissections. Cancer 2011;. © 2011 American Cancer Society.