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. 2025 May 1;8(5):e2510717.
doi: 10.1001/jamanetworkopen.2025.10717.

Long-Term Survival in Patients With Low-Risk Cervical Cancer After Simple, Modified, or Radical Hysterectomy

Christopher M Tarney  1   2 , Chunqiao Tian  1   2   3 , Leslie M Randall  1   4   5 , S Ahmed Hussain  1   2 , Pouya Javadian  1   2 , Sean P Cronin  1   2 , Sara Drayer  1   2 , John K Chan  6 , Daniel S Kapp  7 , Chad A Hamilton  8 , Charles A Leath 3rd  9 , Doris M Benbrook  10 , Christina R Washington  10 , Kathleen N Moore  10 , Nicholas W Bateman  1   2   3 , Thomas P Conrads  1   2   5 , Neil T Phippen  11 , G Larry Maxwell  1   2   5 , Kathleen M Darcy  1   2   3
Affiliations

Long-Term Survival in Patients With Low-Risk Cervical Cancer After Simple, Modified, or Radical Hysterectomy

Christopher M Tarney et al. JAMA Netw Open. .

Abstract

Importance: Three-year pelvic recurrence rate in women with low-risk cervical carcinoma was not inferior following simple hysterectomy (SH) vs modified radical hysterectomy (MRH) or radical hysterectomy (RH) in the Simple Hysterectomy and Pelvic Node Assessment randomized clinical trial, but the survival analysis of the trial was underpowered.

Objective: To evaluate long-term survival in low-risk cervical carcinoma following SH vs MRH or RH.

Design, setting, and participants: This cohort study included women undergoing SH, MRH or RH in US Commission on Cancer-accredited facilities participating in the National Cancer Database who received a diagnosis between January 2010 and December 2017 of 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.

Exposure: SH, MRH, or RH following diagnosis of stage IA2 or IB1 squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix.

Main outcomes and measures: Survival was the primary end point, evaluated with and without propensity score balancing. Survival rates, survival distributions, adjusted hazard ratio (aHR) of death, and restricted mean survival times (RMST) were analyzed as of September 2024. Two multivariable models were fitted. Model 1 included the hysterectomy type and 9 baseline factors (age, comorbidity score, race and ethnicity, insurance status, treatment facility, stage, histologic subtype, tumor grade, and surgical approach). Model 2 included the model 1 variables plus 4 additional clinical factors (surgical margin, LVSI, pathologic LN metastasis, and adjuvant treatment).

Results: This cohort study evaluated 2636 women (mean [SD] age, 45.4 [11.4] years; median [IQR] follow-up, 85 [64-110] months), including 982 with SH, 300 with MRH, 927 with traditional RH, and 427 with unspecified MRH or RH. Survival was similar following SH vs MRH or RH (7 year survival rate, 93.9%; 95% CI, 91.9%-95.4% vs 95.3%; 95% CI, 94.0%-96.3%%; P = .07) and SH vs MRH vs RH (7 year survival rate, 93.9%; 95% CI, 91.9%-95.4% vs 94.2%; 95% CI, 90.1%-96.7% vs 95.4%; 95% CI, 93.6%-96.6%; P = .15). Risk of death following either SH vs MRH or RH, SH vs RH, or MRH vs RH remained similar after adjusting for baseline covariates alone or baseline covariates plus clinical factors. Survival remained similar within subsets by age, comorbidity score, race and ethnicity, facility type, stage, histologic subtype, tumor grade, surgical approach, and year of diagnosis. Adjusted survival remained similar in patients with SH vs MRH or RH after propensity score balancing for baseline covariates (aHR, 1.19; 95% CI, 0.86-1.65; P = .31) with similar 3-year (98.3%; 95% CI, 97.2%-99.0% vs 97.6%; 95% CI, 96.6%-98.2%), 5-year (95.9%; 95% CI, 94.3%-97.1% vs 96.5%; 95% CI, 95.5%-97.3%), 7-year (94.5%; 95% CI, 92.5%-95.9% vs 95.1%; 95% CI, 93.7%-96.1%), and 10-year (89.8%; 95% CI, 86.3%-92.5% vs 91.7%; 95% CI, 89.4%-93.4%) survival rates. Sensitivity analysis for patients who received a diagnosis between 2010 and 2013 documented similar 10-year RMST following SH vs MRH or RH, SH vs RH, SH vs MRH, and MRH vs RH.

Conclusions and relevance: In this cohort study, long-term survival was similar following SH vs MRH or RH, supporting the use of SH in select patients with low-risk early-stage cervical carcinoma.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Randall reported receiving grants from Merck, Genmab, Seagen, and the Gynecologic Oncology Group Foundation; personal fees from Pfizer, the Gynecologic Oncology Group Foundation, Caris Life Sciences, Esai, and Natera; and nonfinancial support from AstraZeneca, GSK, and the Gynecologic Oncology Group Foundation; and serving as steering committee Chair for a clinical trial outside the submitted work. Dr Chan reported receiving personal fees from Astra Zeneca, Daiichi Sankyo, Eisai, Ethicon, Genmab, GSK, Immunogen, Karyopharm Therapeutics, Merck, Myriad Genetics, Seagen, AbbVie, and Pfizer outside the submitted work. Dr Hamilton reported receiving personal fees from GSK, AbbVie, Merck, and AstraZeneca outside the submitted work. Dr Moore reported receiving personal fees from Abbvie, AstraZeneca, Aadi Bioscience, Caris Life Sciences, Duality Technologies, BioNTech, Eisai, GSK, Immunogen, Janssen, Lilly, Merck, Novartis, Regeneron, Verastem Oncology, Zentalis Pharmaceuticals, Corcept Therapeutics, Daiichi Sankyo, Takeda, Schrodinger, Zymeworks, Mersana Therapeutics, and Tubulis; and serving as Associate Director for Gynecologic Oncology Group Partners (reimbursed), American Society of Clinical Oncology Board of Directors (not reimbursed), Gynecologic Oncology Group Foundation board of directors (not reimbursed) outside the submitted work. Dr Conrads reported receiving personal fees from Thermo Fisher Scientific (scientific advisory board member) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Adjusted Risk of All-Cause Death by Type of Hysterectomy and Clinical Covariates in the Original Cohort of Patients With Low-Risk Early-Stage Cervical Carcinoma
Two multivariable Cox models were fitted. Model 1 (A) included the hysterectomy type and 9 baseline factors. Model 2 (B) included the model 1 variables plus 4 additional clinical factors. Other race and ethnicity included American Indian, Aleutian, Inuit, and Yupik patients, and patients with missing race or ethnicity.
Figure 2.
Figure 2.. Adjusted Survival Estimates
Adjusted survival was estimated using weighted Kaplan-Meier method in the propensity-score balanced cohort after applying inverse probability of treatment weighting. Adjusted hazard ratios (aHRs) for risk of death in simple hysterectomy (SH) vs modified radical hysterectomy (MRH) or radical hysterectomy (RH) were estimated using a weighted Cox model, with 95% CIs calculated using a robust sandwich covariance and inserted within the survival distribution plot.
Figure 3.
Figure 3.. Postoperative Metrics Following Simple Hysterectomy (SH) and Modified Radical Hysterectomy (MRH) or Radical Hysterectomy (RH)
Proportions between the SH and MRH or RH groups were propensity score balanced and compared using weighted χ2 tests. LVSI indicates lymphovascular space invasion.
See this image and copyright information in PMC

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