[en] [en] OBJECTIVE: To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer.
METHODS: In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort.
RESULTS: A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy.
CONCLUSIONS: Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.
Disciplines :
Oncology
Author, co-author :
Boria, Felix ; Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
Chiva, Luis ; Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain lchiva@unav.es
Chacon, Enrique ; Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
Zanagnolo, Vanna; Istituto Europeo di Oncologia, Milan, Italy
Fagotti, Anna ; Agostino Gemelli IRCCS, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy ; Catholic University of the Sacred Heart, Milano, Lombardia, Italy
Kucukmetin, Ali; Queen Elizabeth Hospital, Gateshead, Gateshead, UK
Mom, Constantijne; Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
Chakalova, Galina; University Oncologic Hospital, Sofia, Bulgaria
Shamistan, Aliyev; National Center of Oncology, Baku, Azerbaijan
Malzoni, Mario; Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
Narducci, Fabrice; Department of Gynecology, Centre Oscar Lambret, Lille, France
Arencibia, Octavio; Department of Gynecology, University Maternal Hospital Canary Islands, Las Palmas, Las Palmas, Spain
Raspagliesi, Francesco; Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Toptas, Tayfun ; Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
Cibula, David; Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
Kaidarova, Dilyara; Department of Oncogynecology, Kazahskij naucno-issledovatel'skij institut onkologii i radiologii, Almaty, Kazakhstan
Meydanli, Mehmet Mutlu ; Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
Tavares, Mariana; IPO-PORTO, Porto, Portugal
Golub, Dmytro; Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv Region, Ukraine
Perrone, Anna Myriam ; Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
Poka, Robert ; Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Zusterzeel, Petra L M; Department of Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
Aluloski, Igor; Department of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopjeskopje, Macedonia
Goffin, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Haidopoulos, Dimitrios; Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
Haller, Herman; Clinical Hospital Center Rijeka, Rijeka, Croatia
Jach, Robert; Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
Yezhova, Iryna; Lviv Oncology Center, Lviv, Ukraine
Bernardino, Margarida; Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
Bharathan, Rasiah; University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
Maenpaa, Minna M; Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
Sukhin, Vladyslav ; Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Harkiv, Ukraine ; Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Harkiv, Ukraine
Feron, Jean-Guillaume; Institut Curie, Paris, Île-de-France, France
Fruscio, Robert ; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy ; Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
Kukk, Kersti; North Estonia Medical Centre, Tallinn, Estonia
Ponce, Jordi; Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
Demirkiran, Fuat; Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
Vorgias, George; Metaxa Cancer Hospital of Piraeus, Piraeus, Attika, Greece
Povolotskaya, Natalia; Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, UK
Coronado Martín, Pluvio J; Department of Obstetrics and Gynecology, Hospital Clinico San Carlos IdISSC, Complutense University, Madrid, Spain
Marina, Tiermes ; Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
Zapardiel, Ignacio ; Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
Bizzarri, Nicolò ; UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
Gorostidi, Mikel ; Hospital Universitario Donostia, San Sebastian, Spain
Gutierrez, Monica; Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
Manzour, Nabil ; Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Navarra, Spain
Berasaluce, Arantxa; Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
Martin-Calvo, Nerea; ,Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
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