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Survival After Simple Compared With Radical Hysterectomy for Patients With Early-Stage Cervical Cancer
David Viveros-Carreño1, Nuria Agusti, Chi-Fang Wu
1Unidad Ginecología Oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo-CTIC, the Department of Gynecologic Oncology, Clínica Universitaria Colombia, the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, and Gynecologic Oncology, Clínica Astorga, Medellín, Colombia; the Department of Gynecologic Oncology and Reproductive Medicine and the Department of Health Services Research, University of Texas MD Anderson Cancer Center, and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Objective:
To assess the effect on overall survival of simple hysterectomy with lymph node staging compared with radical hysterectomy with lymph node staging for patients with early-stage cervical cancer.
Methods:
We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with early cervical carcinoma of 2 cm or smaller (stage IA1 with lymphovascular space invasion through IIA1, International Federation of Gynecology and Obstetrics staging) from 2010 to 2019. After 1:1 propensity score matching, we compared patients who underwent simple hysterectomy with lymph node staging and those with radical hysterectomy with lymph node staging. The variables used for matching were age, tumor size, race and ethnicity, lymphovascular space invasion, year of diagnosis, Charlson-Deyo comorbidity score, histology, and surgical approach. The primary outcome was overall survival at the end of follow-up. Secondary outcomes included 30-day readmission rate and 30- and 90-day mortality rates.
Results:
In total, 4,167 patients met the inclusion criteria, of whom 2,637 patients (63.3%) underwent radical hysterectomy and lymph node staging and 1,530 patients (36.7%) underwent simple hysterectomy and lymph node staging. After propensity score matching, 1,529 patients in each group were included. There was no statistically significant difference in overall survival between patients who underwent simple hysterectomy and those who underwent radical hysterectomy (hazard ratio 1.25, 95% CI, 0.91-1.73, P =.17). Subgroup analysis by histology, lymphovascular space invasion, tumor size, and surgical approach did not reveal statistically significant differences in overall survival according to hysterectomy type. The hysterectomy groups also did not significantly differ in 30-day readmission rate (4.6% vs 4.2%, P =.73), 30-day mortality rate (0.1% vs 0%, P =.14), or 90-day mortality rate (0.1% vs 0.1%, P =.93).
Conclusion:
Patients with low-risk cervical cancer could undergo less radical surgery without a negative effect on their oncologic outcomes.
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