TOPLINE:

Fertility-preserving hormonal therapy use for early-stage endometrial cancer increased from 5.2% in 2004 to 13.8% in 2020. Survival with that treatment was comparable to that with hysterectomy in patients younger than 40 years but significantly worse in those aged 40-49 years.

METHODOLOGY:

• There is growing interest in treating endometrial cancer with progesterone-based therapy for fertility preservation. This reflects increased cases of patients with this type of cancer who have not completed childbearing due to delayed childbearing trends.
• Analysis included 15,849 women with clinical stage I endometrial cancer diagnosed from 2004 to 2020, including 14,662 (92.5%) treated with primary hysterectomy and 1187 (7.5%) with hormonal therapy.
• Researchers utilized data from the National Cancer Database, which captures clinical data from more than 1500 Commission on Cancer-accredited facilities across the US.
• Propensity score matching was employed to compare survival outcomes between primary hysterectomy and hormonal therapy groups, with median follow-up of 59.5 months.
• Primary treatment was defined based on days from diagnosis to operation or fertility-preserving hormonal therapy, with survival measured at 2-year, 5-year, and 10-year intervals.

TAKEAWAY:

• Among patients younger than 40 years, 5-year survival was comparable between hysterectomy (98.5%; 95% CI, 97.2%-99.2%) and hormonal therapy (98.2%; 95% CI, 96.8%-99.0%) with the hazard ratio (HR) being 1.00 (95% CI, 0.50-2.00).
• For patients aged 40-49 years, hormonal therapy was associated with significantly increased risk for death (HR, 4.94; 95% CI, 1.89-12.91) with 5-year survival of 90.4% vs 99.4% for hysterectomy.
• Overall survival analysis showed 5-year rates of 98.5% (95% CI, 97.3%-99.2%) for hysterectomy vs 96.8% (95% CI, 95.3%-97.8%) for hormonal therapy (HR, 1.84; 95% CI, 1.06-3.21).
• Among patients receiving hormonal therapy, 206 (19.5%) ultimately underwent hysterectomy during first-course treatment, with 63.3% having surgery within 3 months of starting hormonal therapy.

IN PRACTICE:

“While overall survival in patients with hormonal therapy is shorter than with hysterectomy, survival for patients younger than 40 years of age is comparable after primary treatment with fertility-preserving hormonal therapy or hysterectomy...However, for patients aged 40 to 49 years, fertility-preserving hormonal therapy was associated with a significantly increased risk of death,” the authors of the study wrote.

SOURCE:

This study was led by Yukio Suzuki, MD, PhD, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons in New York. It was published online on August 28 in JAMA Oncology.

LIMITATIONS:

According to the authors, pathologic stage was unavailable for 57.2% of patients in the primary hormonal therapy cohort. Additionally, the researchers noted that detailed information about the type of hormonal therapy used, including route of administration, dosage, adherence, and duration of therapy, was lacking. The database also did not capture information about BMI, which is significant as obesity is a major cause of endometrial cancer.

DISCLOSURES:

This study was supported by grants from the Department of Health and Human Services, the National Institutes of Health, and the National Cancer Institute. Suzuki reported no relevant conflicts of interest. 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.