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Description
Ovarian cancer is the leading cause of death from a gynecological malignancy and the fifth leading cause of cancer mortality for women in the United States. The quality of initial surgery for correct staging is one of the most important prognostic factors that also carry therapeutic implications. Optimal surgical staging requires the removal of ovaries, fallopian tubes, uterus and omentum as well as samples of lymph nodes, peritoneum and peritoneal washings. However, only 50% of ovarian cancer patients undergo the correct procedure. In particular, lymph node assessment has been shown to increase survival, but the practice has not been routine in surgical staging. Therefore, we would like to determine whether a significant regional variation in the utilization of lymph node assessment for optimal surgical staging in early-stage epithelial ovarian cancer exists in the United States. A population-based, retrospective cohort study obtained and analyzed data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute's database. Among women with early-stage epithelial ovarian cancer (n=5,243) in the U.S. from 2000 to 2008, over 32% of patients went without lymph node assessment. The receipt of lymph node assessment was analyzed by these fifteen geographical regions, determined by the SEER registry data for each woman was obtained from. Multivariate logistic regression analyses, controlling for tumor characteristics, sociodemographic and socioeconomic factors, resulted in a significant difference in the assessment of lymph nodes among SEER regions (p<0.0001). Significant regional variations found may imply access to health care issues for women with early-stage epithelial ovarian cancer and should be further analyzed to identify modifiable factors in hopes of eliminating any health disparities within the population.
