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

Felix Boria, Luis Chiva, Enrique Chacon, Vanna Zanagnolo, Anna Fagotti, Ali Kucukmetin, Constantijne Mom, Galina Chakalova, Aliyev Shamistan, Mario Malzoni, Fabrice Narducci, Octavio Arencibia, Francesco Raspagliesi, Tayfun Toptas, David Cibula, Dilyara Kaidarova, Mehmet Mutlu Meydanli, Mariana Tavares, Dmytro Golub, Anna Myriam PerroneRobert Poka, Petra L.M. Zusterzeel, Igor Aluloski, Frederic Goffin, Dimitrios Haidopoulos, Herman Haller, Robert Jach, Iryna Yezhova, Margarida Bernardino, Rasiah Bharathan, Minna M. Maenpaa, Vladyslav Sukhin, Jean Guillaume Feron, Robert Fruscio, Kersti Kukk, Jordi Ponce, Fuat Demirkiran, George Vorgias, Natalia Povolotskaya, Pluvio J. Coronado Martín, Tiermes Marina, Ignacio Zapardiel, Nicolò Bizzarri, Mikel Gorostidi, Monica Gutierrez, Nabil Manzour, Arantxa Berasaluce

    Research output: Contribution to journalArticleScientificpeer-review


    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.

    Original languageEnglish
    Pages (from-to)1236-1243
    Number of pages8
    JournalInternational journal of gynecological cancer
    Issue number10
    Publication statusPublished - 3 Oct 2022
    Publication typeA1 Journal article-refereed

    Publication forum classification

    • Publication forum level 1

    ASJC Scopus subject areas

    • Oncology
    • Obstetrics and Gynaecology


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