Regional variation in surgical assessment of lymph nodes for staging among women with early-stage epithelial ovarian cancer

Abstract

Objective: To investigate geographical and socioeconomic variations in performance of lymph node dissection for the evaluation of patients with early-stage epithelial ovarian cancer.

Methods: A population-based, retrospective cohort study was conducted using data from the National Cancer Institute's SEER Program for 15 geographic registries and county-level measures. Women with early-stage epithelial ovarian cancer registered between 2000 and 2008 with known lymph node assessment status were studied. A multiple logistic regression analysis was used to evaluate the differences in the likelihood of lymph node assessment according to geographic SEER region.

Results: After adjusting for tumor characteristics, demographics, and area-based socioeconomic measures, a significant relationship between SEER region and lymph node dissection remained. Compared to the region with the highest proportion of lymph node dissection, there is a significantly lower probability of surgical assessment of lymph nodes in 8 of the remaining 14 geographical regions.

Conclusions: The variation in ovarian cancer surgical care by region reported in this study has implications for access and outcomes for patients with early-stage disease. Study findings merit further investigation and should be characterized to permit targeted interventions aimed at reducing the observed disparities.

Keywords: Lymph node dissection; Lymphadenectomy; Ovarian cancer; Regional variation.