Radical Hysterectomy Versus Simple Hysterectomy and Brachytherapy for Patients with Stage II Endometrial Cancer

Abstract BACKGROUND: To compare the survival outcome between radical hysterectomy and simple hysterectomy with implants radiation 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 (simple hysterectomy combined with brachytherapy or radical hysterectomy). The primary outcome was the rate of overall survival and cause-specific survival of two groups.RESULTS: A total of 1349 patients were enrolled in the study, 117(7.35%) patients received radical hysterectomy and 460 patients who received simple hysterectomy and 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 mortality was 62.31% among women who underwent radical hysterectomy which was lower than 78.48% among those who underwent simple hysterectomy and 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 simple hysterectomy and 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 EC both on cause-specific survival and overall survival. Grade 3 low-risk endometrial cancer was only found with lower overall survival not cause-specific survival.CONCLUSIONS: This study revealed that in patients’ stage II high-risk endometrial cancer, radical hysterectomy radiation was associated with shorter overall survival and cause-specific survival than simple hysterectomy and vaginal brachytherapy.