The Impact of Age on Quality Measure Adherence in Colon Cancer

Abstract

BACKGROUND Recently lymph node yield (LNY) has been endorsed as a quality measure of CC resection adequacy. It is unclear whether this measure is relevant to all ages. We hypothesized that total lymph node yield (LNY) is negatively correlated with increasing age and overall survival (OS). STUDY DESIGN The Surveillance, Epidemiology and End Results (SEER) database was queried for all non-metastatic CC patients diagnosed from 1992–2004 (n=101,767), grouped by age (<40, 41–45, 46–50, and in 5-year increments until 86+ years). Proportions of patients meeting the 12 LNY minimum criterion were determined in each age group, and analyzed with multivariate linear regression adjusting for demographics and AJCC 6th Edition stage. Overall survival (OS) comparisons in each age category were based on the guideline of 12 LNY. RESULTS Mean LNY decreased with increasing age (18.7 vs. 11.4 nodes/patient, youngest vs. oldest group, P<0.001). The proportion of patients meeting the 12 LNY criterion also declined with each incremental age group (61.9% vs. 35.2% compliance, youngest vs. oldest, P<0.001). Multivariate regression demonstrated a negative effect of each additional year in age and log (LNY) with coefficient of −0.003 (95% CI −0.003 to −0.002). When stratified by age and nodal yield using the 12 LNY criterion, OS was lower for all age groups in Stage II CC with <12LNY, and each age group over 60 years with <12LNY for Stage III CC (P<0.05). CONCLUSIONS Every attempt to adhere to proper oncological principles should be made at time of CC resection regardless of age. The prognostic significance of the 12 LN minimum criterion should be applied even to elderly CC patients.

Management of colon cancer in the elderly: a population‐based study

“…The largest study, comprising 47 455 patients in Great Britain and Ireland, had a stage distribution similar to the present results [2]. A smaller lymph node yield in the elderly has been described in previous publications [3,12]. Steele et al [3] found a 3.4% decrease in lymph-node yield for each 5-year interval between the ages of 40 and 86 years or more.…”

Mesocolic Lymph Node Number, Size, and Density

“…51 a decline in ln number with advancing age has been described in nondiseased lns and in the context of colon cancer. 5,17,30,52 in the present study, no correlation was found between ln number and age, but because the cadavers were all aged more than 74 years, this relationship cannot be adequately tested. Low-power photomicrographs of lymph nodes from sigmoid mesocolon stained with H&E illustrating focal lipomatosis involving less than 50% of lymph node (A), diffuse lipomatosis involving more than 50% of the lymph node (fibrous capsule visible in adjacent section) (B), and multiple fluid-filled cavities in the medullary zone (C and D).…”

The Impact of Age on Colorectal Cancer Incidence, Treatment, and Outcomes in an Equal-Access Health Care System

“…1 according to the surveillance epidemiology and end Result database, from 2000 to 2008, there was a 10% overall increase in CRC, with the largest proportion in those <50 years of age versus a 20% decrease in those >50 years of age. 2,3 some studies suggest that young patients with CRC have a relatively worse prognosis, but others suggest that young patients' survival is equivalent to older individuals when risk-adjusted for comorbid variables. [4][5][6] Contributing factors to age-associated disparities in CRC outcomes have included problems with access to health care, delays in diagnosis, treatment, and follow-up differences.…”