Variation in Adequate Lymph Node Yield for Gastric, Lung, and Bladder Cancer: Attributable to the Surgeon, Pathologist,
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ORIGINAL ARTICLE – HEALTH SERVICES RESEARCH AND GLOBAL ONCOLOGY
Variation in Adequate Lymph Node Yield for Gastric, Lung, and Bladder Cancer: Attributable to the Surgeon, Pathologist, or Hospital? Christopher T. Aquina, MD, MPH1 , Matthew Truong, MD2, Carla F. Justiniano, MD, MPH1, Roma Kaur, MD1, Zhaomin Xu, MD, MPH1, Francis P. Boscoe, PhD3, Maria J. Schymura, PhD3, and Adan Z. Becerra, PhD1 1
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY; 2Department of Urology, University of Rochester Medical Center, Rochester, NY; 3New York State Cancer Registry, New York State Department of Health, Albany, NY
ABSTRACT Background. The Commission on Cancer recently released quality-of-care measures regarding adequate lymphadenectomy for colon, gastric, lung, and bladder cancer. There is currently little information regarding variation in adequate lymph node yield (ALNY) for gastric, lung, and bladder cancer. Methods. The New York State Cancer Registry and Statewide Planning and Research Cooperative System were queried for stage I–III gastric, stage I–II lung, and stage II– III bladder cancer resections from 2004 to 2014. Hierarchical models assessed factors associated with ALNY (gastric C 15; lung C 10; bladder C 2). Additionally, the proportions of variation attributable to surgeons, pathologists, and hospitals were estimated among Medicare patients. Results. Among 3716 gastric, 18,328 lung, and 1512 bladder cancer resections, there were low rates of ALNY (gastric = 53%, lung = 36%, bladder = 67%). When comparing 2004–2006 and 2012–2014, there was significant improvement in ALNY for gastric cancer (39% vs. 68%), but more modest improvement for lung (33% vs. 38%) and bladder (65% vs. 71%) cancer. Large providerlevel variation existed for each organ system. After
Ó Society of Surgical Oncology 2020 First Received: 6 May 2019; Published Online: 6 May 2020 C. T. Aquina, MD, MPH e-mail: [email protected]; [email protected]
controlling for patient-level factors/variation, the majority of variation was attributable to hospitals (gastric: surgeon = 4%, pathologist = 2.8%, hospital = 40%; lung: surgeon = 13.8%, pathologist = 1.5%, hospital = 18.3%) for gastric and lung cancer. For bladder cancer, most of the variation was attributable to pathologists (surgeon = 3.3%, pathologist = 10.5%, hospital = 6.2%). Conclusions. ALNY rates are low for gastric, lung, and bladder cancer, with only modest improvement over time for lung and bladder cancer. Given that the proportion of variation attributable to the surgeon, pathologist, and hospital is different for each organ system, future quality improvement initiatives should target the underlying causes, which vary by individual organ system.
Adequate lymph node yield (ALNY) is critical for accurate pathologic oncologic staging and subsequent treatment, and multiple studies have demonstrated that suboptimal lymphadenectomy may have a detrimental effect on long-term survival.
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