Association of Radical Hysterectomy Surgical Volume and Survival for Early-Stage Cervical Cancer. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Matsuo, Koji; Shimada, Muneaki; Yamaguchi, Satoshi; Matoda, Maki; Nakanishi, Toru; Kikkawa, Fumitaka; Ohmichi, Masahide; Okamoto, Aikou; Sugiyama, Toru; Mikami, Mikio
• Is Part Of: Obstetrics and gynecology. Volume 133:Issue 6(2019)
• Publication Date: 2019-06
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/AOG.0000000000003280
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : OBJECTIVE: 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. Abstract : Radical hysterectomy at high-volume centers may be associated with improved survival of women with early-stage cervical cancer.