July 23, 2008 Why do patients with gastric or pancreatic cancer live longer when they are treated at cancer centers or high-volume hospitals than patients treated at low-volume or community hospitals?
New research from Northwestern University's Feinberg School of Medicine found that cancer patients have more lymph nodes examined for the spread of their disease if they are treated at hospitals performing more cancer surgeries or those designated as comprehensive cancer centers.
Lymph node metastases (indicating the spread of cancer) have been shown to predict patients' prognosis after cancer tissue is removed from the stomach or pancreas. If too few lymph nodes are examined for malignant cells, a patient's cancer may be incorrectly classified, which alters the prognosis, treatment decisions and eligibility for clinical trials.
"The differences in nodal evaluation may contribute to improved long-term outcomes at cancer centers and high-volume hospitals for patients with gastric and pancreatic cancer," said Karl Bilimoria, M.D., lead author of the paper and a surgical resident at the Feinberg School.
Current guidelines recommend evaluating at least 15 regional lymph nodes for gastric and pancreatic cancer, according to the study.
Researchers reported that patients at a high-volume hospital or a hospital designated as a National Cancer Institute comprehensive cancer center or as part of the National Comprehensive Cancer Network were more likely to have at least 15 lymph nodes evaluated than patients undergoing surgery at community or low-volume hospitals.
"Every reasonable attempt should be made to assess the optimal number of lymph nodes to accurately diagnose stage disease in patients with gastric and pancreatic cancer," said Bilimoria, who also is a research fellow at the American College of Surgeons. "The status of patients' lymph nodes is a powerful predictor of their outcome."
The study was published in the July issue of Archives of Surgery.
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- Karl Y. Bilimoria; Mark S. Talamonti; Jeffrey D. Wayne; James S. Tomlinson; Andrew K. Stewart; David P. Winchester; Clifford Y. Ko; David J. Bentrem. Effect of Hospital Type and Volume on Lymph Node Evaluation for Gastric and Pancreatic Cancer. Arch Surg., 2008;143(7):671-678 [link]
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