Loading ...

TOPLINE:

Long-term survival analysis reveals comparable outcomes between simple hysterectomy and modified radical hysterectomy (MRH) or radical hysterectomy (RH) in women with low-risk cervical carcinoma.

METHODOLOGY:

• RH with bilateral pelvic lymphadenectomy has historically been the recommended treatment for patients with cervical cancer not desiring fertility. This procedure, which involves removal of cervix, uterus, parametria, and upper vagina, has achieved overall survival rates up to 90%.
• Despite high survival rates, RH carries 10%-15% risk for postoperative complications including hemorrhage, bowel dysfunction, ureteral fistula, voiding dysfunction, sexual dysfunction, and reduced quality of life.
• The new analysis included women diagnosed between January 2010 and December 2017 with International Federation of Gynecology and Obstetrics 2009 stage IA2 or IB1 squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix (< 2 cm) and clinically negative lymph nodes.
• Participants comprised 2636 women (mean age, 45.4 ± 11.4 years) with median follow-up of 85 months, including 982 who underwent simple hysterectomy, 300 with MRH, 927 with traditional RH, and 427 with unspecified MRH or RH.
• Risk assessment involved two multivariable models — one adjusting for nine baseline factors and another extending to include four additional clinical factors including surgical margin, lymphovascular space invasion, pathologic lymph node metastasis, and adjuvant treatment.

TAKEAWAY:

• Seven-year survival rates were comparable between groups: 93.9% (95% CI, 91.9%-95.4%) for simple hysterectomy vs 95.3% (95% CI, 94.0%-96.3%) (P = .07) for MRH or RH.
• Propensity score–balanced analysis showed similar adjusted survival rates at 3 years (98.3% vs 97.6%), 5 years (95.9% vs 96.5%), 7 years (94.5% vs 95.1%), and 10 years (89.8% vs 91.7%) between simple hysterectomy and MRH or RH groups.
• Sensitivity analysis for patients diagnosed between 2010 and 2013 demonstrated similar 10-year restricted mean survival time following simple hysterectomy vs MRH or RH (mean difference, −1.33; 95% CI, −3.69 to 1.03; P = .27).

IN PRACTICE:

“In this cohort study, long-term survival was similar following [simple hysterectomy] vs MRH or RH, supporting the use of [simple hysterectomy] in select patients with low-risk early-stage cervical carcinoma,” the authors of the study wrote.

SOURCE:

This study was led by Christopher M. Tarney, MD, and Kathleen M. Darcy, PhD, from the Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center in Bethesda, Maryland. It was published online on May 15 in JAMA Network Open.

LIMITATIONS:

Researchers could not perform central surgicopathologic review of cases or evaluate details regarding treatments or recurrence rates. This study design inherently involved possibilities for selection bias, confounding, and loss to follow-up. Additionally, investigators were unable to explain utilization rates of simple hysterectomy between 2010 and 2017, examine data on late complications (especially bladder complications), time to disease failure and sites of failure, or investigate quality of life.

DISCLOSURES:

This study received funding through awards from the Uniformed Services University of the Health Sciences from the Defense Health Program to the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. Leslie M. Randall, MD, reported receiving grants from Merck, Genmab, Seagen, and the Gynecologic Oncology Group Foundation, along with personal fees from multiple pharmaceutical companies. John K. Chan, MD, disclosed receiving personal fees from various pharmaceutical companies, including AstraZeneca, Daiichi Sankyo, and GSK. Chad A. Hamilton, MD, reported receiving personal fees from GSK, AbbVie, Merck, and AstraZeneca. Kathleen N. Moore, MD, disclosed receiving personal fees from numerous pharmaceutical companies and serving in various organizational roles. Thomas P. Conrads, PhD, reported receiving personal fees from Thermo Fisher Scientific as a scientific advisory board member. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.