In a U.S. cohort study reported in JAMA Oncology, Suzuki et al assessed long-term survival among premenopausal women with clinical stage I endometrioid endometrial cancer treated with fertility-preserving hormonal therapy vs hysterectomy.
Study Details
The study focused on National Cancer Database data from women aged 18 to 49 years with clinical stage I, grade 1 to 2, endometrioid endometrial cancer diagnosed from 2004 through 2020. Propensity-score matching was used to compare overall survival among patients treated primarily with fertility-preserving hormonal therapy vs those treated with hysterectomy. Data were analyzed from November 2023 to January 2024.
Key Findings
A total of 15,849 women were included in the analysis, including 14,662 (92.5%) treated with primary hysterectomy (mean age = 44 years) and 1,187 (7.5%) treated with primary hormonal therapy (mean age = 34 years). The use of hormonal treatment increased from 5.2% in 2004 to 13.8% in 2020 (P < .001).
In the propensity-score matching analysis, including 1,039 patients in each group, the 5-year overall survival rate was 96.8% (95% confidence interval [CI] = 95.3%–97.8%) in the primary hormonal therapy group vs 98.5% (95% CI = 97.3%–99.2%) in the primary hysterectomy group (hazard ratio [HR] = 1.84, 95% CI = 1.06–3.21).
Among patients aged younger than 40 years, no significant difference in 5-year overall survival was observed between the hormonal therapy group and the hysterectomy group (98.2% vs 98.5%, HR = 1.00, 95% CI = 0.50–2.00). However, among patients aged 40 to 49 years, 5-year overall survival was significantly poorer in the hormonal therapy group (90.4% vs 99.4%, HR = 4.94, 95% CI = 1.89–12.91).
The investigators concluded: “This study found that the use of fertility-preserving hormonal therapy among reproductive age patients with early-stage endometrial cancer has increased over time. While overall survival in patients with hormonal therapy is shorter than with hysterectomy, survival for patients younger than 40 years of age is comparable after primary treatment with fertility-preserving hormonal therapy or hysterectomy.”
Jason D. Wright, MD, of the Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, is the corresponding author of the JAMA Oncology article.
Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of all study authors, visit jamanetwork.com.
