Association of Radical Hysterectomy Surgical Volume and Survival for Early-Stage Cervical Cancer.
Association of Radical Hysterectomy Surgical Volume and Survival for Early-Stage Cervical Cancer.
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早期宫颈癌的根治性子宫切除术和生存的关联。
DOI：
10.1097/aog.0000000000003280
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发表时间：
2019-06
影响因子：
7.2
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中科院分区：
文献类型：
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研究早期宫颈癌患者行根治性子宫切除术后手术量与生存率之间的关系。这是一项全国性多中心回顾性研究，研究了2004年至2008年接受根治性子宫切除术和盆腔淋巴结切除术的临床分期为IB 1-IIB的连续女性（N= 5，964）。5年期间每家临床试验机构的手术量定义为低手术量（少于32例手术，46家[39.7%]机构，n=649 [10.9%]），中等手术量（32-104例手术，60家[51.7%]机构，n= 3，662 [61.4%]）和高手术量（105例或更多手术，10家[8.6%]机构，n= 1，653 [27.7%]）。采用多变量分析和倾向评分匹配检查手术体积特异性生存率。每家临床试验机构的中位手术数量为44例（四分位数范围，17-65）。IB 1-IIB期疾病的5年无病生存率分别为77.2%，79.9%和84.5%，低，中和高容量组。在多变量分析中，与中等容量中心相比，高容量中心的女性复发风险（校正风险比[HR] 0.69，95% CI 0.58-0.82，P<0.001）和全因死亡率（校正HR 0.73，95% CI 0.59-0.90，P= 0.003）降低。具体而言，与中等容量中心相比，高容量中心的女性局部复发风险降低（校正HR 0.62，95% CI 0.49-0.78，P<0.001），但远端复发风险未降低（校正HR 0.85，95% CI 0.67-1.06，P= 0.142）。在1，700名仅接受手术治疗的临床IB 1期疾病女性中，在大容量中心进行手术与复发风险降低相关（校正HR 0.45，95% CI 0.25-0.79，P= 0.006）和全因死亡率多变量分析中，与中等容量中心的手术相比，（校正HR 0.29，95% CI 0.11-0.76，P= 0.013）。倾向评分匹配后，多变量分析显示，与中、低手术量中心相比，高手术量中心的手术仍然是降低复发率（校正HR 0.69，95% CI 0.57-0.84，P<0.001）和全因死亡率（校正HR 0.75，95% CI 0.59-0.95，P= 0.016）的独立预后因素。根治性子宫切除术的住院量可能是早期宫颈癌的一个预后因素。在高容量中心进行手术与降低局部复发风险和提高生存率相关。
To examine the association between surgical volume and survival of women with early-stage cervical cancer who underwent radical hysterectomy. 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. 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. 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.