Gauthier Bouche

Increased hospital case volume is associated with improved survival and quality of care for uterine corpus cancer in Belgium.

This study aimed to prospectively evaluate whether hospital case volume is positively associated with both the outcome and the quality of care of uterine corpus cancer in Belgium. This was a prospective, observational, registration-based, real-world database study. Hospital case volume was categorized according to the total number of patients treated on average per year: low (<10/y), medium (10-19/y), and high (≥20/y). Adjusting for patient case mix and intra-hospital correlations, logistic and Cox proportional hazards regression were used to test for associations between hospital case volume and a multi-disciplinary set of process and outcome indicators. Sub-group analyses by recurrence risk were performed for overall survival and disease-free survival. In total, 4178 patients diagnosed with a primary cancer of the uterine corpus between 2012 and 2016 in Belgium were included. Compared with patients treated in high-volume hospitals, patients treated in low-volume hospitals were more likely to die of any cause within 5 years after diagnosis (adjusted hazard ratio 1.37, p < .01), as were patients treated in medium-volume hospitals (adjusted hazard ratio 1.18, p < .05). Similar results were observed in the sub-group analyses, but only among patients with high-intermediate-risk and high-risk disease. In contrast, hazards for disease-free survival did not differ by hospital case volume, neither in the total study population nor in the sub-group analyses by recurrence risk. Furthermore, analysis of the process indicators showed that patients treated in low- and medium-volume hospitals were less likely to receive multiple guideline-recommended procedures compared with those treated in high-volume hospitals, including minimally invasive surgery, surgical lymph node staging, staging omentectomy, and adjuvant chemotherapy. On average, increased hospital case volume was positively associated with improved overall survival and quality of care, supporting centralization of uterine corpus cancer care into high-volume reference centers in Belgium.