Higher Surgical Volume May Improve Outcomes in Cervical Cancer

Surgery at high-volume centers is associated with decreased local recurrence risk and improved survival for women with early-stage cervical cancer, according to a study published in the June issue of Obstetrics & Gynecology.

Koji Matsuo, M.D., Ph.D., from the University of Southern California in Los Angeles, and colleagues used nationwide, multicenter retrospective data to assess consecutive women with clinical stage IB1 to IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy from 2004 to 2008 (5,964 patients). During the five-year period, the surgical volume per site was defined as low-volume (<32 surgeries, 46 institutions; 649 patients), mid-volume (32 to 104 surgeries, 60 institutions; 3,662 patients), and high-volume (≥105 surgeries, 10 institutions; 1,653 patients).

The researchers found that the median number of surgeries per site was 44. For low-, mid-, and high-volume groups, the five-year disease-free survival rates among stage IB1 to IIB disease were 77.2, 79.9, and 84.5 percent, respectively. Versus mid-volume centers, women treated in high-volume centers had a decreased risk for recurrence (adjusted hazard ratio [aHR], 0.69; 95 percent confidence interval [CI], 0.58 to 0.82; P = 0.001) and all-cause mortality (aHR, 0.73; 95 percent CI, 0.59 to 0.90; P = 0.003). Women treated at high-volume centers had a decreased risk for local recurrence (aHR, 0.62; 95 percent CI, 0.49 to 0.78; P < 0.001) but not distant recurrence (aHR, 0.85; 95 percent CI, 0.67 to 1.06; P = 0.142) versus those treated at mid-volume centers. After propensity score matching, surgery at high-volume centers continued to be an independent prognostic factor for decreased recurrence (aHR 0.69; 95 percent CI, 0.57 to 0.84; P = 0.001) and all-cause mortality (aHR, 0.75; 95 percent CI, 0.59 to 0.95; P = 0.016) versus surgery at mid- and low-volume centers.

"Hospital volume for radical hysterectomy may be a prognostic factor for early-stage cervical cancer," the authors write.

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