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Long-Term Survival in Patients With Low-Risk Cervical Cancer After Simple, Modified, or Radical Hysterectomy
Christopher M Tarney1,2, Chunqiao Tian1,2,3, Leslie M Randall1,4,5
1Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland.
Simple hysterectomy (SH) offers similar long-term survival outcomes as modified radical hysterectomy (MRH) or radical hysterectomy (RH) for low-risk cervical cancer. This supports SH as a viable option for select early-stage patients.
Area of Science:
- Gynecologic Oncology
- Surgical Oncology
- Clinical Trials
Background:
- Low-risk cervical carcinoma management involves surgical options like simple hysterectomy (SH), modified radical hysterectomy (MRH), and radical hysterectomy (RH).
- Previous studies, including the Simple Hysterectomy and Pelvic Node Assessment trial, indicated similar short-term recurrence rates but were underpowered for survival analysis.
Purpose of the Study:
- To evaluate and compare the long-term survival rates of women with low-risk cervical carcinoma treated with SH versus MRH or RH.
- To determine if SH is a non-inferior surgical option in terms of long-term oncologic outcomes.
Main Methods:
- A cohort study analyzing data from the National Cancer Database (2010-2017) of women diagnosed with stage IA2 or IB1 cervical cancer.
- Included 2636 women undergoing SH, MRH, or RH, with survival analyzed using multivariable models and propensity score balancing.
- Primary endpoint was survival, with secondary analyses including hazard ratios and restricted mean survival times.
Main Results:
- No significant difference in 7-year survival rates was observed between SH and MRH/RH groups (93.9% vs 95.3%, P=.07).
- Adjusted analyses, including propensity score balancing, confirmed similar risks of death across all comparison groups (aHR for SH vs MRH/RH: 1.19).
- Long-term survival rates (3, 5, 7, and 10 years) remained comparable between SH and MRH/RH after adjusting for multiple covariates.
Conclusions:
- Long-term survival outcomes are similar for patients with low-risk, early-stage cervical carcinoma treated with SH compared to MRH or RH.
- Simple hysterectomy (SH) can be considered a suitable surgical option for select patients with early-stage cervical cancer, offering comparable survival benefits.
- These findings support the broader application of SH in appropriate patient populations, potentially reducing surgical morbidity.
