Patients who do not undergo hysterectomy for low-grade endometrial cancer may be at higher risk of death

1. In this cohort study, patients with early-stage, low-grade endometrial cancer who did not undergo hysterectomy, specifically those from racial and ethnic minorities or age extremes, had significantly higher risks of death from endometrial cancer, cardiovascular disease, and all-cause mortality, compared to those who did. 

Evidence Rating Level: 2 (Good)

For patients with presumed early-stage, low-grade endometrial cancer, standard treatment is hysterectomy with bilateral salpingo-oophorectomy and lymph node evaluation, yielding a 5-year survival of 95%. Some patients, such as those willing to preserve their fertility or who are medically inoperable, may receive medical management instead, typically with progestin-based therapy, with surgery recommended after childbearing. Prior data on outcomes for patients who do not undergo surgery are limited. Thus, the study aimed to compare patient characteristics and outcomes in those with grade 1, stage IA endometrioid adenocarcinoma who did or did not undergo hysterectomy, examining cancer-specific survival, cardiovascular disease (CVD) deaths, and overall mortality by surgery status and age. A total of 27,331 patients with grade 1, stage IA endometrioid adenocarcinoma met the inclusion criteria for analysis (S1), including 26,984 (98.7%) who underwent hysterectomy and 347 (1.3%) who did not. Among patients 18-49 years, non-Hispanic White patients were least likely to undergo hysterectomy (2.8%) compared with Hispanic (4.9%), Asian or Pacific Islander (4.0%), and Black patients (8.2%) (P<.001). There were several reasons why patients did not undergo a hysterectomy, with the most common being not recommended by the clinician (42.1%). Over a median follow-up of four years, deaths from endometrial cancer were rare, occurring in 0.8% of all patients. However, those who did not undergo hysterectomy had significantly higher mortality across all categories, with higher rates of endometrial cancer-related death (4.2% vs 1.2%), CVD (7.8% vs 2.1%) and all-cause mortality (23% vs 8.2%) compared to those who underwent surgery. Overall, in a cohort of patients with low-grade, stage IA endometrioid adenocarcinoma, not undergoing surgery was associated with increased risk of mortality.

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