Survival Outcomes of Cervical Cancer Patients Treated in Certified Gynecologic Cancer Centers Versus Non-Certified Hospitals: Findings from a German Retrospective Cohort Study (WiZen)

Abstract Cervical cancer is the fourth most prevalent malignancy among women worldwide, with more patients treated in specialized centers. The WiZen study examines whether treatment at German Cancer Society-certified centers improves survival. This cohort study uses data from eleven statutory health insurance funds (SHI) and four population-based clinical cancer registries (CCRs) in Germany. The analysis includes 10596 incident cervical cancer cases from the AOK dataset and 3468 patients from the CCR dataset who received initial treatment for cervical cancer (ICD-10-GM code C53) between 2009 and 2017. Survival was compared between patients treated at certified centers and non-certified units, using Kaplan–Meier estimators and multivariable Cox models with adjustment for patient and hospital characteristics. Based on SHI data, the 5-year overall survival rate estimated by the Kaplan–Meier method was 59.1% for patients treated at certified centers, compared to 53.3% for those at non-certified hospitals. According to CCR data, the corresponding survival rates were 61.6% and 53.2%, respectively. In both cases the survival benefit was highly significant (Log rank p < 0.001). Multivariable hazard ratios (HRs) for mortality favored treatment in certified centers, with an HR of 0.839 (SHI data; 95% confidence interval [CI]: 0.757–0.930; p = 0.001) and 0.741 (CCR data; 95% CI: 0.634–0.865; p < 0.001). The findings of this analysis indicate that initial treatment in certified gynecologic cancer centers is associated with a significant survival advantage and should be further promoted as a component of high-quality oncologic care.