Lymph Node Evaluation for XXXX and Its Value as a Quality Metric.

@entity1 @entity788 @entity204
BACKGROUND: Adequate lymph node evaluation (LNE) is recommended for surgically treated @entity788 because studies have shown an association between improved survival and adequate LNE. This study aimed to understand the mechanism of this association and determine whether LNE is a valuable quality metric. METHODS: Using the linked Surveillance Epidemiology End Results Medicare database, we identified @entity1 with surgically treated @entity788 from 2000 to 2010. Adequate LNE was defined as evaluation of >= 15 nodes. Survival was determined using Kaplan-Meier and Cox proportional hazards. RESULTS: We identified 2629 @entity1 who underwent resection for @entity788 . Overall, 33  % had adequate LNE. Adequate LNE was significantly associated with receipt of postoperative chemotherapy. A significant decrease in hazard of @entity204 was associated with adequate LNE (HR 0.86, p   <   0.05). Receipt of postoperative chemotherapy was also significantly associated with @entity204 (HR 0.77, p   <   0.05). On unadjusted analysis, the survival benefit associated with adequate LNE was lost when stratified by receipt of postoperative chemotherapy. CONCLUSION: The survival benefit associated with LNE is in part derived from the fact that @entity1 who receive adequate LNE are also more likely to receive chemotherapy. Thus, the use of lymph node counts has limitations as a quality metric.
