Table 2.
Association of Surgical Volume and Survival in Cervical Cancer (Adjusting Model)
| Characteristic | Disease-Free Survival |
Overall Survival |
Local Recurrence |
Distant Recurrence |
||||
|---|---|---|---|---|---|---|---|---|
| HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | |
|
| ||||||||
| All cases (prematching) | ||||||||
| Mid-volume | 1 | 1 | 1 | 1 | ||||
| High-volume | 0.69 (0.58–0.82) | <.001 | 0.73 (0.59–0.90) | .003 | 0.62 (0.49–0.78) | <.001 | 0.85 (0.67–1.06) | .142 |
| Low-volume | 1.09 (0.89–1.33) | .397 | 0.91 (0.69–1.20) | .509 | 0.95 (0.72–1.24) | .696 | 0.93 (0.70–1.25) | .645 |
| All cases (postmatching) | ||||||||
| Mid- and low-volume | 1 | 1 | 1 | 1 | ||||
| High-volume | 0.69 (0.57–0.84) | <.001 | 0.75 (0.59–0.95) | .016 | 0.65 (0.50–0.85) | .001 | 0.78 (0.61–1.02) | .066 |
| Stage IB1 disease* | ||||||||
| Mid-volume | 1 | 1 | 1 | 1 | ||||
| High-volume | 0.45 (0.25–0.79) | .006 | 0.29 (0.11–0.76) | .013 | 0.37 (0.19–0.73) | .004 | 0.54 (0.21–1.39) | .200 |
| Low-volume | 0.99 (0.54–1.84) | .982 | 0.31 (0.07–1.36) | .121 | 0.95 (0.49–1.87) | .890 | 0.56 (0.13–2.45) | .439 |
| Stage IIB disease | ||||||||
| Mid-volume | 1 | 1 | 1 | 1 | ||||
| High-volume | 0.72 (0.53–0.96) | .027 | 0.77 (0.55–1.08) | .133 | 0.66 (0.45–0.98) | .038 | 0.85 (0.58–1.26) | .423 |
| Low-volume | 0.89 (0.63–1.26) | .496 | 0.88 (0.58–1.34) | .549 | 0.73 (0.45–1.19) | .207 | 0.82 (0.51–1.34) | .433 |
| Node-positive case | ||||||||
| Mid-volume | 1 | 1 | 1 | 1 | ||||
| High-volume | 0.76 (0.60–0.97) | .025 | 0.76 (0.57–0.99) | .044 | 0.66 (0.47–0.92) | .013 | 0.88 (0.66–1.18) | .394 |
| Low-volume | 0.82 (0.62–1.11) | .197 | 0.82 (0.58–1.16) | .258 | 0.80 (0.53–1.20) | .279 | 0.76 (0.52–1.13) | .175 |
HR, hazard ratio.
Association for surgical volume and survival outcome was adjusted for pretreatment factors, surgical-pathologic results, and treatment types (adjusting model 3). Pretreatment factors: age (continuous), year of diagnosis (2004, 2005, 2006, 2007, and 2008), and histology (squamous vs nonsquamous). Surgical-pathologic factors: pelvic lymph node metastasis (yes vs no), para-aortic lymph node metastasis (yes, no, or not examined), parametrial involvement (yes vs no), deep stromal invasion (yes vs no), lympho-vascular space invasion (yes vs no), tumor size (more than 4 cm vs 4 cm or less), uterine corpus invasion (yes vs no), ovarian metastasis (yes vs no), and malignant peritoneal cytology (yes, no, or not examined). Treatment types: neoadjuvant chemotherapy (yes vs no) and adjuvant therapy (radiation-based, chemotherapy-based, or none). Cox proportional hazard regression models were used for analysis. Proportional hazard assumption was tested and showed no interaction with time.
Bold indicates significant P-value.
Clinical stage IB1 disease without preoperative or postoperative chemotherapy or radiotherapy.