Study: Simple hysterectomy survival comparable to more radical procedures in early cervical cancer

Editor's Note

Simple hysterectomy provides similar long-term survival outcomes to modified radical or radical hysterectomy for patients with low-risk, early-stage cervical cancer, according to a large cohort study published May 15 in JAMA Network Open. Consistent with prior research, the findings add to the growing body of evidence supporting conservative surgery as a viable option for select patients.

Researchers analyzed outcomes for 2,636 patients diagnosed between 2010 and 2017 with FIGO 2009 stage IA2 or IB1 squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma (tumor size ≤2 cm, clinically negative nodes). Patients underwent simple hysterectomy (SH), modified radical hysterectomy (MRH), or radical hysterectomy (RH) at Commission on Cancer–accredited US facilities.

Survival was similar, with 7-year survival rates of  93.9% for SH vs 95.3% for MRH or RH (P = .07) and 10-year rates of 89.8% for SH vs 91.7% for MRH or RH. Survival remained similar across all subgroups defined by age, comorbidity, race and ethnicity, tumor grade, histology, surgical approach, stage, and facility type. Postoperative outcomes were also comparable, including positive surgical margin (2.5% for SH vs 2.0% for MRH or RH) lymphovascular space invasion (LVSI; 22.4% vs 24.3%) pathologic lymph node metastasis (3.5% vs 4.7%); 30-day readmission rate (5.1% vs 4.8%) use of adjuvant radiotherapy (16% vs 14.7%); and use of chemotherapy: 9.7% vs 9.4%

Although this cohort included more patients with grade 3 tumors and LVSI than prior prospective trials such as SHAPE, the findings still demonstrated equivalent long-term survival after SH compared to more radical procedures, authors write. They caution that this result may partly reflect higher use of adjuvant treatment in the SH group and emphasize that conclusions should be limited to patients meeting low-risk criteria. Additionally, the observational design precludes firm causal inferences, and the study could not assess quality-of-life outcomes or late complications.