Regional variation in surgical assessment of lymph nodes for staging among women with early-stage epithelial ovarian cancer.
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.
San Diego State University Graduate School of Public Health, San Diego, CA, USA.
Kathleene T
KT
Ulanday
Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA, USA.
Kristy K
KK
Ward
San Diego State University Graduate School of Public Health, San Diego, CA, USA.
Caroline A
CA
Macera
San Diego State University Graduate School of Public Health, San Diego, CA, USA.
Ming
M
Ji
Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA, USA. Electronic address: splaxe@ucsd.edu.
Steven C
SC
Plaxe
D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D018426:SEER Program
Lymph node dissection; Lymphadenectomy; Ovarian cancer; Regional variation