Similar Survival With Simple and Radical Hysterectomy in Early Cervical Cancer

 Among women with low-risk, early-stage cervical cancer, long-term survival outcomes were similar following simple, modified radical, or radical hysterectomy, according to an observational cohort study.

For more than 2,600 patients, 7-year survival rates were 93.9% with simple hysterectomy versus 94.2% with modified radical hysterectomy and 95.4% with radical hysterectomy (P=0.15), reported Kathleen M. Darcy, PhD, of Walter Reed National Military Medical Center in Annandale, Virginia, and colleagues.

Similar rates were observed within subsets by age, comorbidity score, race and ethnicity, facility type, stage, histologic subtype, tumor grade, surgical approach, and year of diagnosis, they noted in JAMA Network Openopens in a new tab or window.

"Less radical surgery did not come at the expense of postoperative metrics including surgical findings, 30-day readmissions, or administration of adjuvant radiation or chemotherapy," wrote Darcy and colleagues, adding that the data "complement the results from SHAPEopens in a new tab or window supporting the use and safety of conservative surgery in patients with low-risk, early-stage cervical carcinoma."

In explaining the rationale behind the study, Darcy and colleagues noted that while overall survival with radical hysterectomy is in the 90% range, the procedure is associated with risks of postoperative complications, including hemorrhage, bowel dysfunction, ureteral fistula, voiding dysfunction, sexual dysfunction, and worse quality of life.

Moreover, previous studies have suggested that more conservative options can be successfully used for low-risk, early-stage cervical cancer. The SHAPE trial, for example, showed that simple hysterectomy was not inferior to radical hysterectomy in terms of pelvic recurrence rates, and there were fewer complications with the simple approach.

"These results supported changes to National Comprehensive Cancer Network guidelines that include conservative surgery as an option in management of patients with low-risk early-stage cervical carcinoma," the authors noted. "There remain questions whether there are differences in short- and long-term survival for patients with low-risk, early-stage cervical carcinoma undergoing conservative surgery."

For this study, Darcy and colleagues evaluated 2,636 women (mean age 45.4 years) treated at U.S. Commission on Cancer-accredited facilities, who were 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.

Of these women, 982 underwent simple hysterectomy, 300 underwent modified radical hysterectomy, 927 underwent traditional radical hysterectomy, and 427 underwent unspecified modified radical hysterectomy or radical hysterectomy. Most patients (86.8%) had stage IB1 disease, and 15.6% received adjuvant therapy, including 17.8% in the simple hysterectomy group and 14.3% in the modified radical hysterectomy or radical hysterectomy group.

Survival remained similar in patients who underwent simple hysterectomy versus modified radical hysterectomy or radical hysterectomy after propensity score balancing for baseline covariates (adjusted HR 1.19, 95% CI 0.86-1.65, P=0.31), with similar survival rates:

• 3-year: 98.3% vs 97.6%
• 5-year: 95.9% vs 96.5%
• 7-year: 94.5% vs 95.1%
• 10-year: 89.8% vs 91.7%

Darcy and team also looked at certain postoperative outcomes following simple hysterectomy versus modified radical hysterectomy or radical hysterectomy and found similar rates of positive surgical margins (2.5% vs 2.0%), presence of lymphovascular space invasion (22.4% vs 24.3%), pathologic lymph node metastasis (3.5% vs 4.7%), 30-day hospital readmission rates (5.1% vs 4.8%), utilization of radiotherapy (16.0% vs 14.7%), and administration of chemotherapy (9.7% vs 9.4%).

They acknowledged that their study had limitations, noting that their findings "must be interpreted cautiously given our study design and higher rates of grade 3 disease, [lymphovascular space invasion], and utilization of adjuvant therapy in our study."

Disclosures

This research was funded by an award 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, Gynecologic Cancer Center of Excellence Program.

Darcy had no disclosures.

Co-authors reported relationships with Merck, Genmab, Seagen, the Gynecologic Oncology Group Foundation, Pfizer, Caris Life Sciences, Eisai, Natera, AstraZeneca, GSK, Daiichi Sankyo, Immunogen, Karyopharm Therapeutics, Myriad Genetics, AbbVie, Aadi Bioscience, Duality Technologies, BioNTech, Janssen, Lilly, Novartis, Regeneron, Verastem Oncology, Zentalis Pharmaceuticals, Corcept Therapeutics, Takeda, Schrodinger, Zymeworks, Mersana Therapeutics, Tubulis, and Thermo Fisher Scientific.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowTarney CM, et al "Long-term survival in patients with low-risk cervical cancer after simple, modified, or radical hysterectomy" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.10717.

https://www.medpagetoday.com/hematologyoncology/cervicalcancer/115630