Surgery for endometrial cancers with suspected cervical involvement: is radical hysterectomy needed (a GOTIC study)?

Abstract

Background: Radical hysterectomy is recommended for endometrial adenocarcinoma patients with suspected gross cervical involvement. However, the efficacy of operative procedure has not been confirmed.

Methods: The patients with endometrial adenocarcinoma who had suspected gross cervical involvement and underwent hysterectomy between 1995 and 2009 at seven institutions were retrospectively analysed (Gynecologic Oncology Trial and Investigation Consortium of North Kanto: GOTIC-005). Primary endpoint was overall survival, and secondary endpoints were progression-free survival and adverse effects.

Results: A total of 300 patients who underwent primary surgery were identified: 74 cases with radical hysterectomy (RH), 112 patients with modified radical hysterectomy (mRH), and 114 cases with simple hysterectomy (SH). Median age was 47 years, and median duration of follow-up was 47 months. There were no significant differences of age, performance status, body mass index, stage distribution, and adjuvant therapy among three groups. Multi-regression analysis revealed that age, grade, peritoneal cytology status, and lymph node involvement were identified as prognostic factors for OS; however, type of hysterectomy was not selected as independent prognostic factor for local recurrence-free survival, PFS, and OS. Additionally, patients treated with RH had longer operative time, higher rates of blood transfusion and severe urinary tract dysfunction.

Conclusion: Type of hysterectomy was not identified as a prognostic factor in endometrial cancer patients with suspected gross cervical involvement. Perioperative and late adverse events were more frequent in patients treated with RH. The present study could not find any survival benefit from RH for endometrial cancer patients with suspected gross cervical involvement. Surgical treatment in these patients should be further evaluated in prospective clinical studies.

Figure 1

(A) Local recurrence-free curves of all patients according to the type of hysterectomy. There was no significant difference among three groups. Five-year survival rates were 88.0% in RH, 89.6% in mRH, and 87.9% in SH group, respectively. There was no significant difference among three groups. (B) Local recurrence-free curves of the patients that had pathological cervical stromal involvement according to the type of hysterectomy. There was no significant difference in OS among three groups. Five-year survival rates were 86.4% in RH, 87.9% in mRH, and 86.5% in SH group, respectively. There was no significant difference among three groups.

Figure 2

(A) Overall survival curves of all cases according to the type of hysterectomy. Five-year overall survival rates were 83.6% in RH, 85.6% in mRH, and 84% in SH group, respectively. There was no significant difference in OS among three groups. (B) PFS curves of all patients according to the type of hysterectomy. Five-year PFS rates were 71.6% in RH, 77.7% in mRH, and 66.4% in SH group, respectively. There was no significant difference in PFS among three groups.

Figure 3

(A) Overall survival curves of the patients who had pathological cervical stromal involvement only (current FIGO stage II diseases) according to the type of hysterectomy. Five-year OS rates were 89.5% in RH, 86.0% in mRH, and 92.4% in SH group, respectively. There was no significant difference in OS among three groups. (B) PFS curves of the patients who had pathological cervical stromal involvement only (current FIGO stage II diseases) according to the type of hysterectomy. Five-year PFS rates were 74.1% in RH, 80.9% in mRH, and 70.1% in SH group, respectively. There was no significant difference in PFS among three groups.