SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer

Boria F. Chiva L. Chacon E. Zanagnolo V. Fagotti A. Kucukmetin A. Mom C. Chakalova G. Shamistan A. Malzoni M. Narducci F. Arencibia O. Raspagliesi F. Toptas T. Cibula D. Kaidarova D. Meydanli M.M. Tavares M. Golub D. Perrone A.M. Poka R. Zusterzeel P.L.M. Aluloski I. Goffin F. Haidopoulos D. Haller H. Jach R. Yezhova I. Bernardino M. Bharathan R. Maenpaa M.M. Sukhin V. Feron J.-G. Fruscio R. Kukk K. Ponce J. Demirkiran F. Vorgias G. Povolotskaya N. Coronado Martín P.J. Marina T. Zapardiel I. Bizzarri N. Gorostidi M. Gutierrez M. Manzour N. Berasaluce A.
3 October 2022 BMJ Publishing Group

International Journal of Gynecological Cancer
2022 #32 Issue 10 1236 - 1243 pp.

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.

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Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Spain
Department of Gynecologic Oncology, Universidad de Navarra, Navarra, Pamplona, Spain
Istituto Europeo di Oncologia, Milan, Italy
Agostino Gemelli IRCCS, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Catholic University of the Sacred Heart, Lombardia, Milano, Italy
Queen Elizabeth Hospital, Gateshead, Gateshead, United Kingdom
Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
University Oncologic Hospital, Sofia, Bulgaria
National Center of Oncology, Baku, Azerbaijan
Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
Department of Gynecology, Centre Oscar Lambret, Lille, France
Department of Gynecology, University Maternal Hospital Canary Islands, Las Palmas, Las Palmas, Spain
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey
Department of Obstetrics and Gynecology, University of Prague, Prague, Czech Republic
Department of Oncogynecology, Kazahskij naucno-issledovatelskij institut onkologii i radiologii, Almaty, Kazakhstan
Department of Gynecologic Oncology, Zekai Tahir Burak Womens Health Education and Research Hospital, Ankara, Turkey
IPO-PORTO, Porto, Portugal
Department of Surgery, LISOD - Israeli Oncological Hospital, Kyiv, Ukraine
Division of Gynecologic Oncology, IRCCS Azienda Ospedaliero, Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Institute of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Department of Gynecological Oncology, Radboudumc, Nijmegen, Netherlands
Department of Gynecologic Oncology, University Clinic of Gynecology and Obstetrics, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, North Macedonia
Department of Obstetrics and Gynecology, University of Liege, Liege, Belgium
Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
Clinical Hospital Center Rijeka, Rijeka, Croatia
Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
Lviv Oncology Center, Lviv, Ukraine
Department of Gynecology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
Department of Oncology, Radiology and Radiation Medicine, V N Karazin Kharkiv National University, Kharkiv, Ukraine
Department of Oncogynecology, Grigoriev Institute for Medical Radiology NAMS of Ukraine, Kharkiv, Ukraine
Institut Curie, Paris, Île-de-France, France
Department of Medicine and Surgery, University of Milan–Bicocca, Milan, Italy
Clinic of Obstetrics and Gynecology, Hospital San Gerardo, Monza, Italy
North Estonia Medical Centre, Tallinn, Estonia
Bellvitge University Hospital, LHospitalet de Llobregat, Catalunya, Spain
Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
Metaxa Cancer Hospital of Piraeus, Attika, Piraeus, Greece
Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth NHS Trust, Portsmouth, United Kingdom
Department of Obstetrics and Gynecology, Hospital Clinico San Carlos IdISSC, Complutense University, Madrid, Spain
Department of Gynecologic Oncology, La Fe University, Polytechnic Hospital, Valencia, Spain
Department of Gynecologic Oncology, La Paz University Hospital, Madrid, Spain
UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
Hospital Universitario Donostia, San Sebastian, Spain
Department of Preventive Medicine and Public Health, Clinica Universidad de Navarra, Navarra, Pamplona, Spain

Department of Obstetrics and Gynecology
Department of Gynecologic Oncology
Istituto Europeo di Oncologia
Agostino Gemelli IRCCS
Catholic University of the Sacred Heart
Queen Elizabeth Hospital
Amsterdam University Medical Centres
University Oncologic Hospital
National Center of Oncology
Endoscopica Malzoni
Department of Gynecology
Department of Gynecology
Department of Surgery
Department of Gynecologic Oncology
Department of Obstetrics and Gynecology
Department of Oncogynecology
Department of Gynecologic Oncology
IPO-PORTO
Department of Surgery
Division of Gynecologic Oncology
Department of Obstetrics and Gynecology
Department of Gynecological Oncology
Department of Gynecologic Oncology
Department of Obstetrics and Gynecology
Division of Gynecologic Oncology
Clinical Hospital Center Rijeka
Department of Gynecology and Oncology
Lviv Oncology Center
Department of Gynecology
University Hospitals of Leicester NHS Trust
Department of Obstetrics and Gynecology
Department of Oncology
Department of Oncogynecology
Institut Curie
Department of Medicine and Surgery
Clinic of Obstetrics and Gynecology
North Estonia Medical Centre
Bellvitge University Hospital
Istanbul University Cerrrahpasa Medical Faculty
Metaxa Cancer Hospital of Piraeus
Department of Gynaecological Oncology
Department of Obstetrics and Gynecology
Department of Gynecologic Oncology
Department of Gynecologic Oncology
UOC Ginecologia Oncologica
Hospital Universitario Donostia
Department of Preventive Medicine and Public Health

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