Facility Volume and Endometrial Cancer: Treatment Patterns and Outcomes

A multicenter retrospective cohort from Emilia-Romagna, Italy, reported in facility volume and endometrial cancer, compared medium-volume centers (11–29 endometrial cancer cases/year) with high-volume centers (≥30 cases/year) and described differences across operative approach, surgical staging practices, perioperative metrics, adjuvant treatment patterns, and time-to-event outcomes. The analysis included 2,402 patients treated between 2000 and 2019 across participating hospitals. Across the report, center-volume comparisons are presented alongside patient and tumor characteristics and then related to observed differences in recurrence patterns and survival. The article also distinguishes findings from Kaplan–Meier analyses versus multivariable models that adjust for measured case mix.

Baseline differences between patients treated in higher- versus medium-volume facilities are described as part of the study context. The authors report that patients managed at high-volume centers were, on average, slightly younger and had fewer comorbidities, with clinical status differences reflected in American Society of Anesthesiologists (ASA) classifications. They also report variation in the distribution of ESMO–ESGO recurrence-risk classes between settings, with a higher proportion of higher-risk and advanced/metastatic disease categories among patients treated at high-volume centers and a lower proportion of intermediate-risk cases. In subgroup descriptions, the authors note that non-endometrioid histology was more frequent among high-risk patients treated at high-volume centers than among high-risk patients treated at medium-volume centers. These case-mix differences are presented as background for interpreting comparisons of staging intensity, adjuvant use, and outcomes.

Procedural and perioperative patterns also differed by center volume in the authors’ comparisons. High-volume centers reported greater uptake of laparoscopy (58% vs 47%) alongside shorter mean operative time (145 vs 177 minutes), smaller mean hemoglobin variation (−1.6 vs −1.8), and shorter mean hospital stay (5.7 vs 6.5 days). For staging-related measures, peritoneal biopsy was more frequently performed at high-volume centers (27% vs 14%), and the authors report higher lymph node yields (mean 21.5 vs 19) and a higher proportion of patients with positive lymph nodes (4% vs 2%). In risk-stratified analyses, the distribution of pelvic and paraaortic lymph node dissection differed across risk groups and center types, with the largest contrasts described in low- and high-risk categories. The article summarizes these findings as a pattern in which higher-volume facilities more often used minimally invasive surgery and reported more intensive surgical staging, alongside shorter operative times and hospital stays and a smaller hemoglobin decrease.

Adjuvant treatment use and modality mix were reported to vary by center type and by ESMO–ESGO risk group. Overall, adjuvant therapy was less frequent at high-volume centers (40% vs 50%), and risk-stratified results showed lower adjuvant use in both low-risk and high-risk categories at high-volume centers. When adjuvant therapy was administered, the authors report a different modality distribution: among low-risk patients receiving adjuvant therapy, brachytherapy predominated at medium-volume centers, while high-volume centers reported more external-beam radiotherapy and some chemotherapy; among high-risk patients receiving adjuvant therapy, chemotherapy was more common at high-volume centers while radiotherapy was more common at medium-volume centers. Outcome analyses showed better progression-free survival (PFS) and overall survival (OS) for patients treated at high-volume centers on Kaplan–Meier curves, while multivariate Cox analyses retained an independent association between high-volume centers and PFS (adjusted HR approximately 0.60–0.68, depending on the model/subgroup) but not OS after adjustment for age, ASA score, and ESMO–ESGO risk group. The authors present this split between unadjusted and adjusted results as central to their interpretation of volume-linked outcome differences.

Key Takeaways:

• The article reports differences in patient case mix by center volume, including age/comorbidity/ASA profiles and a higher proportion of higher-risk disease categories at high-volume centers.
• Higher-volume centers were reported to use laparoscopy more often and to have more frequent peritoneal biopsy and higher mean lymph node yields (21.5 vs 19), alongside shorter operative times and hospital stays.
• Kaplan–Meier analyses showed better PFS and OS at high-volume centers, while adjusted models maintained an independent association for PFS but not for OS after accounting for measured covariates.