title: Assessing the quality of colorectal cancer staging: documenting the process in improving the staging of node-negative colorectal cancer.
abstract: OBJECTIVE
  Examination of 14 or more nodes is the optimal criterion to accurately stage node-negative colorectal cancer and predict outcome.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Three university-affiliated community medical centers.
  
  
  METHODS
  A total of 2149 individuals with apparently localized, invasive colorectal cancer examined between January 1, 1990, and December 31, 2002.
  
  
  METHODS
  Study of tumor registry data.
  
  
  METHODS
  Nodal status and disease-specific survival.
  
  
  RESULTS
  The number of nodes examined ranged from 0 to 97 (mean +/- SD, 18 +/- 15 nodes). The mean number of nodes examined in node-positive individuals was 21.0 vs 16.6 in node-negative individuals (P<.001). The mean number of nodes examined at medical center A was 22.3; center B, 17.9; and center C, 14.0. The mean number of nodes examined for T3 and T4 tumors at center A was 26; center B, 20; and center C, 16 (P<.001). The node-positive rate for all T3 and T4 lesions was 49.7% at center A, 57.8% at center B, and 50.0% at center C (P<.001). Despite significant differences in the mean number of nodes examined between medical centers, the overall survival in patients with node-negative colorectal cancer in the 3 medical centers was not statistically different (P = .79). The criterion of examining 14 or more nodes distinguished between individuals at low risk for recurrence and those at increased risk.
  
  
  CONCLUSIONS
  Variability exists between medical centers in the pathological analysis of colorectal cancer specimens. However, within an institution, examining a mean of 14 or more nodes accurately stages apparently node-negative colorectal cancer and accurately predicts outcome.
authors.affiliation: Prevention and Control Program, Cancer Research Center of Hawaii, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu 96813, USA. wongj@hawaii.edu
authors.forename: Jan H
authors.initials: JH
authors.lastname: Wong
authors.forename: D Scott
authors.initials: DS
authors.lastname: Johnson
authors.forename: Daphne
authors.initials: D
authors.lastname: Hemmings
authors.forename: Andrew
authors.initials: A
authors.lastname: Hsu
authors.forename: Taryne
authors.initials: T
authors.lastname: Imai
authors.forename: Gail T
authors.initials: GT
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011787:Quality of Health Care; D016019:Survival Analysis