评估每个中心每年进行根治性子宫切除术次数与无病生存和总生存的联系。我们对先前包括在宫颈癌监测协作研究中的患者进行了国际性、多中心、回顾性研究。包括国际妇产科联合会（FIGO）2009年IB1-IIA1期宫颈癌，在根治性子宫切除术中，最后组织学显示淋巴结为阴性的个体。患者在妇科肿瘤转诊中心治疗，遵循最新的国家和国际指南。使用未经调整的Cox比例危险模型来确定手术量的最佳截止值，其中无病生存为结果，并定义为最小化组之间无病生存分割的P值的值。使用倾向得分匹配在基线创建统计相似的队列。共纳入2,157名患者。手术量的两个最显着截止值在七和17次手术中被确定，将整个队列分为低、中、高三个手术量中心。倾向得分匹配后，分析了1,238名患者-619名（50.0％）在高手术量组，523名（42.2％）在中等手术量组，96名（7.8％）在低手术量组。在高手术量机构接受手术的患者的5年无病生存率比在低手术量中心接受手术的患者逐渐变好（92.3％vs 88.9％vs 83.8％，P = 0.029）。5年总生存无差异（95.9％vs 97.2％vs 95.2％，P = 0.70）。Cox多变量回归分析显示，FIGO分期大于IB1、淋巴血管侵犯存在、分级大于1、肿瘤直径大于20 mm、微创手术方法、非鳞状细胞癌组织学和低手术量中心代表了独立的复发风险因素。中心的外科手术量代表了影响无病生存的独立预后因素。每个中心每年进行的根治性子宫切除术次数的增加与改善无病生存相关。版权所有©2022年美国妇产科医师学院。由Wolters Kluwer Health, Inc.出版。保留所有权利。

To evaluate the association of number of radical hysterectomies performed per year in each center with disease-free survival and overall survival.We conducted an international, multicenter, retrospective study of patients previously included in the Surveillance in Cervical Cancer collaborative studies. Individuals with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB1-IIA1 cervical cancer who underwent radical hysterectomy and had negative lymph nodes at final histology were included. Patients were treated at referral centers for gynecologic oncology according to updated national and international guidelines. Optimal cutoffs for surgical volume were identified using an unadjusted Cox proportional hazard model, with disease-free survival as the outcome and defined as the value that minimizes the P-value of the split in groups in terms of disease-free survival. Propensity score matching was used to create statistically similar cohorts at baseline.A total of 2,157 patients were initially included. The two most significant cutoffs for surgical volume were identified at seven and 17 surgical procedures, dividing the entire cohort into low-volume, middle-volume, and high-volume centers. After propensity score matching, 1,238 patients were analyzed-619 (50.0%) in the high-volume group, 523 (42.2%) in the middle-volume group, and 96 (7.8%) in the low-volume group. Patients who underwent surgery in higher-volume institutions had progressively better 5-year disease-free survival than those who underwent surgery in lower-volume centers (92.3% vs 88.9% vs 83.8%, P=.029). No difference was noted in 5-year overall survival (95.9% vs 97.2% vs 95.2%, P=.70). Cox multivariable regression analysis showed that FIGO stage greater than IB1, presence of lymphovascular space invasion, grade greater than 1, tumor diameter greater than 20 mm, minimally invasive surgical approach, nonsquamous cell carcinoma histology, and lower-volume centers represented independent risk factors for recurrence.Surgical volume of centers represented an independent prognostic factor affecting disease-free survival. Increasing number of radical hysterectomies performed in each center every year was associated with improved disease-free survival.Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.