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Association of Radical Hysterectomy Surgical Volume and Survival for Early-Stage Cervical Cancer

Matsuo, Koji MD, PhD; Shimada, Muneaki MD, PhD; Yamaguchi, Satoshi MD, PhD; Matoda, Maki MD; Nakanishi, Toru MD, PhD; Kikkawa, Fumitaka MD, PhD; Ohmichi, Masahide MD, PhD; Okamoto, Aikou MD, PhD; Sugiyama, Toru MD, PhD; Mikami, Mikio MD, PhD

doi: 10.1097/AOG.0000000000003280
Contents: Gynecologic Oncology: Original Research
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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.

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

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; the Department of Obstetrics and Gynecology, Tottori University, Tottori, the Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, the Department of Gynecology, the Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, the Department of Gynecologic Oncology, Aichi Cancer Center Hospital, Aichi, the Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, the Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, the Department of Obstetrics and Gynecology, the Jikei University School of Medicine, Tokyo, the Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, and the Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan.

Corresponding authors: Muneaki Shimada, MD, PhD, Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan; email: muneaki.shimada.b7@tohoku.ac.jp; and Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, California 90033; email: koji.matsuo@med.usc.edu.

Financial Disclosure Dr. Matsuo received honorarium from Chugai, compensation from Springer for a book editorial, and meeting expense fee from VBL therapeutics. The other authors did not report any potential conflicts of interest.

Presented at the 50th annual meeting on Women's Cancer, March 16–19, 2019, Honolulu, Hawaii.

The authors thank all the JGOG institutions that participated in this study, the JGOG Cervical Cancer Committee members for their administrative work on the study, and Dr. Brendan H. Grubbs, MD, for his scientific input.

Peer reviews are available at http://links.lww.com/AOG/B368.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.