In:
Obstetrics & Gynecology, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. 6 ( 2019-06), p. 1086-1098
Abstract:
To examine the association between surgical volume and survival of women with early-stage cervical cancer who underwent radical hysterectomy. METHODS: This is a nationwide multicenter retrospective study examining consecutive women with clinical stage IB1-IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy from 2004 to 2008 (N=5,964). The surgical volume per site over the 5-year period was defined as low-volume (fewer than 32 surgeries, 46 [39.7%] institutions, n=649 [10.9%] ), mid-volume (32–104 surgeries, 60 [51.7%] institutions, n=3,662 [61.4%] ), and high-volume (105 surgeries or more, 10 [8.6%] institutions, n=1,653 [27.7%] ). Surgical volume-specific survival was examined with multivariable analysis and propensity score matching. RESULTS: The median number of surgeries per site was 44 (interquartile range, 17–65). The 5-year disease-free survival rates among stage IB1-IIB disease were 77.2%, 79.9%, and 84.5% for low-, mid-, and high-volume groups, respectively. On multivariable analysis, women in high-volume centers had a decreased risk of recurrence (adjusted hazard ratio [HR] 0.69, 95% CI 0.58–0.82, P 〈 .001) and all-cause mortality (adjusted HR 0.73, 95% CI 0.59–0.90, P =.003) compared with those in mid-volume centers. Specifically, women in high-volume centers had a decreased risk of local recurrence (adjusted HR 0.62, 95% CI 0.49–0.78, P 〈 .001) but not distant recurrence (adjusted HR 0.85, 95% CI 0.67–1.06, P =.142) compared with those in mid-volume centers. Among 1,700 women with clinical stage IB1 disease treated with surgery alone, surgery at high-volume centers was associated with a decreased risk of recurrence (adjusted HR 0.45, 95% CI 0.25–0.79, P =.006) and all-cause mortality (adjusted HR 0.29, 95% CI 0.11–0.76, P =.013) compared with surgery at mid-volume centers on multivariable analysis. After propensity score matching, surgery at high-volume centers remained an independent prognostic factor for decreased recurrence (adjusted HR 0.69, 95% CI 0.57–0.84, P 〈 .001) and all-cause mortality (adjusted HR 0.75, 95% CI 0.59–0.95, P =.016) compared with surgery at mid- and low-volume centers on multivariable analysis. CONCLUSION: Hospital volume for radical hysterectomy may be a prognostic factor for early-stage cervical cancer. Surgery at high-volume centers is associated with decreased local recurrence risk and improved survival.
Type of Medium:
Online Resource
ISSN:
0029-7844
DOI:
10.1097/AOG.0000000000003280
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2012791-1
Permalink