In Reply: Although we found no evidence that hospitals examining more lymph nodes after colectomy for colon cancer had better overall survival rates, both Dr Bilimoria and colleagues and Dr Peters and colleagues suggest that node counts may be particularly important in patients found to have node-negative disease. In our study, hospitals in the highest node count quartile had better survival rates among patients with stage II disease than hospitals in the lowest quartile. Patient-level analyses were conducted as a part of this study, although our focus was assessing lymph node examination rates at the hospital level. Peters et al request additional patient-level survival analysis. Consistent with other patient-level studies, we had reported that examination of at least 12 nodes was associated with improved survival. That association was stronger in patients found to have node-negative disease (adjusted hazard ratio, 0.74;
95% confidence interval, 0.69-0.80) compared with patients with node-positive disease (adjusted hazard ratio, 0.89; 95% confidence interval, 0.81-0.98).
Wong SL, Birkmeyer JD. Lymph Node Examination Rate, Survival Rate, and Quality of Care in Colon Cancer—Reply. JAMA. 2008;299(8):896-898. doi:10.1001/jama.299.8.897