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.

UOC Ginecologia Oncologica Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica and the Biostatistics Unit Scientific Directorate Fondazione Policlinico Universitario A Gemelli IRCCS Rome and the University of Milano Bicocca Department of Obstetrics and Gynecology Gynaecologic Oncology Surgical Unit ASST Monza San Gerardo Hospital Monza Italy; the Gynecologic Oncology Center Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital and the Department of Gynaecology and Obstetrics University Hospital Pilsen Charles University Prague the Department of Obstetrics and Gynecology Faculty of Medicine University Hospital and University of Ostrava Ostrava and the University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic; the Center for Gynaecologic Oncology Amsterdam Amsterdam University Medical Centers Amsterdam the Netherlands; the Department of Gynecological Surgery National Institute of Neoplastic Diseases Lima Peru; the Department of Pelvic Cancer Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden; the Baskent University School of Medicine Department of Gynecology and Obstetrics Division of Gynecologic Oncology and the Department of Gynecologic Oncology Zekai Tahir Burak Women's Health and Research Hospital University of Health Sciences Ankara Turkey; Memorial Sloan Kettering Cancer Center New York New York; the Gynecology Oncology Center National Institute of Cancerology Mexico Mexico City Mexico; the Department of Gynecologic Oncology Instituto Nacional de Cancerología Bogotá Colombia; the Wolfson Institute of Preventive Medicine Barts Cancer Centre Queen Mary University of London and Barts Health NHS Trust London United Kingdom; the Department of Gynecologic Oncology and Reproductive Medicine The University of Texas MD Anderson Cancer Center Houston Texas; the Department of Gynecologic Oncology Hospital Italiano de Buenos Aires Instituto Universitario Hospital Italiano Buenos Aires Argentina; Gynecology Medical University of Graz Graz Austria; the Gynecologic Oncology Unit La Paz University Hospital IdiPAZ Madrid Spain; and the Department of Gynecologic Oncology Barretos Cancer Hospital Barretos Sao Paulo Brazil

Zobrazit více v PubMed

Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71(3):209–249. doi:10.3322/caac.21660 PubMed DOI

He WQ, Li C. Recent global burden of cervical cancer incidence and mortality, predictors, and temporal trends. Gynecol Oncol 2021;163(3):583–592. doi:10.1016/j.ygyno.2021.10.075 PubMed DOI

Bizzarri N, Pletnev A, Razumova Z, et al. Quality of training in cervical cancer radical surgery: a survey from the European Network of Young Gynaecologic Oncologists (ENYGO) [published online ahead of print, 2022 Jan 6]. Int J Gynecol Cancer 2022;ijgc-2021–002812. doi:10.1136/ijgc-2021-002812 PubMed DOI

Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol 2000;18:2327–40. PubMed

Killeen SD, O’Sullivan MJ, Coffey JC, et al. Provider volume and outcomes for oncological procedures. Br J Surg 2005;92:389–402. PubMed

Bristow RE, Palis BE, Chi DS, et al. The National Cancer Database report on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol 2010;118:262–7. PubMed

Bristow RE, Chang J, Ziogas A, et al. High-volume ovarian cancer care: survival impact and disparities in access for advanced-stage disease. Gynecol Oncol 2014;132:403–10. PubMed

Wright JD, Chen L, Hou JY, et al. Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer. Obstet Gynecol 2017;130(3):545–553. doi:10.1097/AOG.0000000000002164 PubMed DOI PMC

Wright JD, Hershman DL, Burke WM, et al. Influence of surgical volume on outcome for laparoscopic hysterectomy for endometrial cancer. Ann Surg Oncol 2012;19(3):948–958. doi:10.1245/s10434-011-2090-8 PubMed DOI

Matsuo K, Nishio S, Matsuzaki S, Machida H, Mikami M. Hospital volume-outcome relationship in vulvar cancer treatment: a Japanese Gynecologic Oncology Group study. J Gynecol Oncol 2021;32(2):e24. doi:10.3802/jgo.2021.32.e24 PubMed DOI PMC

Wright JD, Huang Y, Ananth CV, et al. Influence of treatment center and hospital volume on survival for locally advanced cervical cancer. Gynecol Oncol 2015;139(3):506–512. doi:10.1016/j.ygyno.2015.07.015 PubMed DOI PMC

Lee B, Kim K, Park Y, Lim MC, Bristow RE. Impact of hospital care volume on clinical outcomes of laparoscopic radical hysterectomy for cervical cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2018;97(49):e13445. doi:10.1097/MD.0000000000013445 PubMed DOI PMC

Matsuo K, Shimada M, Yamaguchi S, et al. Association of Radical Hysterectomy Surgical Volume and Survival for Early-Stage Cervical Cancer. Obstet Gynecol 2019;133(6):1086–1098. doi:10.1097/AOG.0000000000003280 PubMed DOI PMC

Gennari P, Gerken M, Mészáros J, et al. Minimal-invasive or open approach for surgery of early cervical cancer: the treatment center matters. Arch Gynecol Obstet 2021;304(2):503–510. doi:10.1007/s00404-020-05947-y PubMed DOI

Cibula D, Dostálek L, Jarkovsky J, et al. The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer [published online ahead of print, 2021 Oct 16]. Eur J Cancer 2021;158:111–122. doi:10.1016/j.ejca.2021.09.008 PubMed DOI PMC

Cibula D, Dostálek L, Jarkovsky J, et al. Post-recurrence survival in patients with cervical cancer. Gynecol Oncol 2022;164(2):362–369. doi:10.1016/j.ygyno.2021.12.018 PubMed DOI PMC

Querleu D, Cibula D, Abu-Rustum NR. 2017 Update on the Querleu-Morrow Classification of Radical Hysterectomy. Ann Surg Oncol 2017;24(11):3406–3412. doi:10.1245/s10434-017-6031-z PubMed DOI PMC

von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 2014;12(12):1495–1499. doi:10.1016/j.ijsu.2014.07.013 PubMed DOI

Kaplan EL, Meier P. Nonparametric estimation from incomplete observation. J Am Stat Assoc 1958;53:457–481.

Mantel N Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966;50(3):163–70. PubMed

Cox DR. Models and Life-Tables Regression. J R Stat Soc Ser B (Methodological) 1972;34(2):187–220.

Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med 2018;379(20):1895–1904. doi:10.1056/NEJMoa1806395 PubMed DOI

Cibula D, Planchamp F, Fischerova D, et al. European Society of Gynaecological Oncology quality indicators for surgical treatment of cervical cancer. Int J Gynecol Cancer 2020;30(1):3–14. doi:10.1136/ijgc-2019-000878 PubMed DOI

Pedone Anchora L, Bizzarri N, Gallotta V, et al. Impact of surgeon learning curve in minimally invasive radical hysterectomy on early stage cervical cancer patient survival. Facts Views Vis Obgyn 2021;13(3):231–239. doi:10.52054/FVVO.13.3.035 PubMed DOI PMC

Li LY, Wen LY, Park SH, et al. Impact of the Learning Curve on the Survival of Abdominal or Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. Cancer Res Treat 2021;53(1):243–251. doi:10.4143/crt.2020.063 PubMed DOI PMC

Dostalek L, Åvall-Lundqvist E, Creutzberg CL, et al. ESGO Survey on Current Practice in the Management of Cervical Cancer. Int J Gynecol Cancer 2018;28(6):1226–1231. doi:10.1097/IGC.0000000000001314 PubMed DOI

Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study