Purpose To compare the survival outcome between radical hysterectomy and total hysterectomy with radiation therapy in patients with stage II endometrial cancer.
Methods This is a retrospective cohort study. We identified 1349 patients diagnosed with stage II endometrial cancer from Jan 1, 1988 to Dec 31 2015 in the Surveillance, Epidemiology, and End Results. Patients were divided into two groups based on the primary treatment (total hysterectomy combined with brachytherapy or radical hysterectomy). All patients received external beam radiation therapy after the surgery. The primary outcome was the rate of 5-year-cause-specific survival and 5-year-overall survival.
Results A total of 1349 patients were enrolled in the study, 117(7.35%) patients received radical hysterectomy and 460 patients who received total hysterectomy combined with vaginal brachytherapy were selected as control. All patients received external beam radiation therapy after the surgery. Overall, the median follow-up duration was 82.77±1.44months (95%CI: 79.94-85.61months). There was no difference in the baseline information between two groups, including ages, ethnicity, and rates of histologic subtypes. The 5-year overall survival was 62.31% among women who underwent radical hysterectomy which was lower than 78.48% among those who underwent total hysterectomy combined with vaginal brachytherapy (HR, 2.22; 95% CI, 1.52 to 3.24; P <0.001 by the log-rank test). Women who underwent radical hysterectomy also had shorter 5-year cause-specific survival (74.60 vs.85.38%; HR, 1.91; 95% CI, 1.13 to 3.23; P =0.01 by the log-rank test) than those who underwent total hysterectomy combined with vaginal brachytherapy. However, the negative outcomes were further validated in patients with high-risk endometrial cancer, not in patients with grade 1-2 low-risk endometrial cancer both on cause-specific survival and overall survival. In patients with grade 3 low-risk endometrial cancer, the tendency was only found with lower overall survival not cause-specific survival.
Conclusions This study revealed that in patients’ stage II endometrial cancer, radical hysterectomy was associated with shorter overall survival and cause-specific survival than total hysterectomy combined with vaginal brachytherapy. The choice of different treatment modalities should base on the histology subtype of patients and further study based on molecular classification is needed.