Frequency and Determinants of Lymph Node Dissection for Node-Negative Cancers of the Biliary Tract Pubblico

Abstract

Background: Adequate lymph node (LN) resection has been shown to be a significant predictor of survival among node-negative cancer patients. These considerations apply to cancers of the gallbladder and of the intra- and extra-hepatic bile ducts. The goals of the present study were 1) to assess the temporal changes in the proportion of node-negative biliary tract cancer cases that were evaluated using 1998 AJCC recommendations for LN resection; and 2) to investigate if the numbers of LN examined during surgery for the three cancers of interest were associated with year or place of diagnosis, patient demographic characteristics, and disease related factors.

Methods: We retrieved information on demographic characteristics, clinical features, and year of diagnosis for 3,093 eligible cases from the population-based Surveillance, Epidemiology and End Results database for the period from 2000 to 2012. Trends in number of LN examined were assessed using the annual percent change in proportion of cases with the number of lymph nodes examined for years 1992 through 2012. The change in trend was tested for statistical significance using a Monte Carlo Permutation method. Multivariable logistic regression models were used to examine factors associated with adherence to LN resection recommendations.

Results: The percentage of patients with at least 3 LN examined ranged from 34% to 57% in the period from 1992 to 2012. Trend analysis indicated a significant increase in the overall proportion of cases with AJCC recommended LN examination during the study period. The results were generally similar using an alternative cutoff of 10+ LN. There was a significant positive association between diagnosis after 2008 and 3 LN examined, with odds ratio (OR) of 1.49 and a 95% confidence interval (CI) from 1.28 to 1.73, and significant associations with older age and primary site.

Conclusion: Our results indicate that half of all reported patients do not receive adequate LN examination. Nevertheless the data indicate that the recommendations have led to a significant increase in proportion of patients receiving adequate staging care.

Table of Contents

Background........................ 1

Methods.............................3

Multivariable Analysis.........4

Trend Analysis....................4

Results...............................5

Discussion..........................7

Conclusions.......................10

References.........................11

Tables...............................16

Table 1..............................16

Table 2..............................17

Table 3..............................18

Figures..............................19

Figure 1.............................19

Figure 2.............................20

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Pathology Health Sciences, Epidemiology
Parola chiave	Lymph node SEER United States Lymphadenectomy Cancer Biliary Tract
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University

Ultima modifica

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Frequency and Determinants of Lymph Node Dissection for Node-Negative Cancers of the Biliary Tract ()	2018-08-28 15:10:50 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions