Bizzarri, Nicolò;
Dostálek, Lukáš;
van Lonkhuijzen, Luc RCW;
Giannarelli, Diana;
Lopez, Aldo;
Falconer, Henrik;
Querleu, Denis;
... Cibula, David; + view all
(2023)
Association of Hospital Surgical Volume With Survival in Early-Stage Cervical Cancer Treated With Radical Hysterectomy.
Obstetrics & Gynecology
, 141
(1)
pp. 207-214.
10.1097/aog.0000000000005026.
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Abstract
OBJECTIVE: To evaluate the association of number of radical hysterectomies performed per year in each center with disease-free survival and overall survival. METHODS: We conducted an international, multicenter, retrospective study of patients previously included in the Surveillance in Cervical Cancer collaborative studies. Individuals with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1–IIA1 cervical cancer who underwent radical hysterectomy and had negative lymph nodes at final histology were included. Patients were treated at referral centers for gynecologic oncology according to updated national and international guidelines. Optimal cutoffs for surgical volume were identified using an unadjusted Cox proportional hazard model, with disease-free survival as the outcome and defined as the value that minimizes the P-value of the split in groups in terms of disease-free survival. Propensity score matching was used to create statistically similar cohorts at baseline. RESULTS: A total of 2,157 patients were initially included. The two most significant cutoffs for surgical volume were identified at seven and 17 surgical procedures, dividing the entire cohort into low-volume, middle-volume, and high-volume centers. After propensity score matching, 1,238 patients were analyzed—619 (50.0%) in the high-volume group, 523 (42.2%) in the middle-volume group, and 96 (7.8%) in the low-volume group. Patients who underwent surgery in higher-volume institutions had progressively better 5-year disease-free survival than those who underwent surgery in lower-volume centers (92.3% vs 88.9% vs 83.8%, P=.029). No difference was noted in 5-year overall survival (95.9% vs 97.2% vs 95.2%, P=.70). Cox multivariable regression analysis showed that FIGO stage greater than IB1, presence of lymphovascular space invasion, grade greater than 1, tumor diameter greater than 20 mm, minimally invasive surgical approach, nonsquamous cell carcinoma histology, and lower-volume centers represented independent risk factors for recurrence. CONCLUSION: Surgical volume of centers represented an independent prognostic factor affecting disease-free survival. Increasing number of radical hysterectomies performed in each center every year was associated with improved disease-free survival. Despite the introduction and implementation of screening and vaccination programs, cervical cancer remains a major burden and is the fourth most common cancer diagnosed worldwide.1 However, incidence is decreasing in many developed countries, leading to a reduction in the caseload of some centers and in the exposure of trainees.2,3 The link between hospital case volume and survival improvement has been demonstrated in several cancers, including gynecologic malignancies.4–10 Concerning cervical cancer, few studies have assessed the association between surgical volume and improved survival.11–14 A recent study aimed to analyze the association between surgical volume and survival of women with early-stage cervical cancer who underwent radical hysterectomy.13 It concluded that hospital volume for radical hysterectomy may be a prognostic factor for early-stage cervical cancer—surgery performed at high-volume centers was associated with decreased risk of local recurrence and improved survival. However, this study reported some limitations, such as the use of a single-country national registry database, lack of information on surgical approach, and average volume calculated over 5 calendar years. In addition, improvement of outcomes may not be related only to superior quality of surgery, but also to adherence to guidelines and to the way multidisciplinary care is organized with the availability of imaging and postoperative radiotherapy. Very recently, the SCCAN (Surveillance in Cervical Cancer) Consortium published two retrospective studies on the annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer15 and on postrecurrence survival in patients with cervical cancer.16 The SCCAN Consortium consists of 20 tertiary care centers of excellence for the treatment of cervical cancer from Europe, Asia, North America, and Latin America. These centers have modern imaging modalities used for clinical staging (magnetic resonance imaging, expert ultrasonography, computed tomography, or positron emission tomography–computed tomography). All cases were discussed by a multidisciplinary team, surgery and pathology were performed by surgeons and pathologists with experience in gynecologic oncology, and institutional follow-up was performed by physicians. The present study aimed to assess the prognostic effect (defined in terms of disease-free and overall survival) of surgical volume per center for patients previously included in the SCCAN collaborative studies.
| Type: | Article |
|---|---|
| Title: | Association of Hospital Surgical Volume With Survival in Early-Stage Cervical Cancer Treated With Radical Hysterectomy |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/aog.0000000000005026 |
| Publisher version: | https://doi.org/10.1097/aog.0000000000005026 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10162117 |
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