# Assessment of ESGO Quality Indicators and Factors Associated with Recurrence Following Surgery for Early-Stage Cervical Cancer: A Retrospective Cohort Study

## TL;DR

This study shows that following specific quality guidelines for cervical cancer surgery improves patient outcomes and reduces recurrence risks.

## Contribution

The study demonstrates the impact of ESGO quality indicators and pre-surgery conization on recurrence in early-stage cervical cancer.

## Key findings

- Systematic MRI and multidisciplinary tumor boards reduced surgical margin positivity and upstaging rates.
- Cervical conization before radical hysterectomy significantly lowered recurrence risk.
- Adherence to ESGO QIs improved progression-free survival but not overall survival.

## Abstract

Background/Objectives: In 2019, the European Society of Gynaecological Oncology (ESGO) published a set of quality indicators (QIs) for the surgical management of cervical cancer with the aim of improving clinical practice. The objective of this study is to evaluate the influence of ESGO QIs and clinicopathological factors on progression-free survival (PFS) in patients with early-stage cervical cancer in a retrospective cohort. Methods: A retrospective study was conducted in patients with early-stage cervical cancer who underwent radical surgery with pelvic lymph node assessment at La Paz University Hospital between 2005 and 2022. The cohort was divided into two groups according to the timing of surgery (before vs. after 2010), when MRI was implemented as a standardized diagnostic tool and the multidisciplinary tumor board was established. Univariate and multivariate Cox regression analyses were performed, including demographic and histopathological variables, as well as adherence to ESGO QIs, focusing on those related to the overall management. Hazard ratios and 95% confidence intervals were estimated. Kaplan–Meier survival curves were generated and compared between groups. Results: The implementation of systematic MRI and a multidisciplinary tumor board at our center was associated with a significant reduction in positive surgical margins (p = 0.003) and parametrial invasion (p < 0.001), as well as improved diagnostic accuracy, lowering the rate of upstaging from 31.6% before 2010 to 4.4% thereafter (p < 0.001). PFS in the post-2010 cohort was significantly improved (log-rank p = 0.0408), although no differences in overall survival (OS) were observed (log-rank p = 0.2602). Additionally, cervical conization prior to radical hysterectomy was associated with a markedly reduced risk of recurrence (HR 0.12, p < 0.001), representing the most significant prognostic factor for PFS in our cohort. Conclusions: The correct application of ESGO QIs, along with appropriate staging and pathological assessment, is essential to improve prognosis in cervical cancer. Systematic implementation of these standards is recommended to optimize clinical care.