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

• DOI: 10.1001/jamanetworkopen.2025.10717
• Publication Date: 2025-05-15T15:00:39Z
• Authors: Christopher M. Ta...; Chunqiao Tian; Leslie M. Randall; S. Ahmed Hussain; Pouya Javadian; Sean P. Cronin; Sara Drayer; John K. Chan; Daniel S. Kapp; Chad A. Hamilton; Charles A. Leath; Doris M. Benbrook; Christina R. Wash...; Kathleen N. Moore; Nicholas W. Bateman; Thomas P. Conrads; Neil T. Phippen; G. Larry Maxwell; Kathleen M. Darcy
• Keywords: Adenosquamous carcinoma

Importance Three-year pelvic recurrence rate in women with low-risk cervical carcinoma was not inferior following simple hysterectomy (SH) vs modified radical (MRH) or (RH) the Simple Hysterectomy and Pelvic Node Assessment randomized clinical trial, but survival analysis of trial underpowered. Objective To evaluate long-term SH MRH RH. Design, Setting, Participants This cohort study included undergoing SH, RH US Commission on Cancer–accredited facilities participating National Cancer Database who received a diagnosis between January 2010 December 2017 International Federation Gynecology Obstetrics 2009 stage IA2 IB1 squamous cell carcinoma, adenocarcinoma, adenosquamous cervix (≤2 cm) clinically negative lymph nodes. Exposure MRH, cervix. Main Outcomes Measures Survival primary end point, evaluated without propensity score balancing. rates, distributions, adjusted hazard ratio (aHR) death, restricted mean times (RMST) were analyzed as September 2024. Two multivariable models fitted. Model 1 type 9 baseline factors (age, comorbidity score, race ethnicity, insurance status, treatment facility, stage, histologic subtype, tumor grade, surgical approach). 2 model variables plus 4 additional (surgical margin, LVSI, pathologic LN metastasis, adjuvant treatment). Results 2636 (mean [SD] age, 45.4 [11.4] years; median [IQR] follow-up, 85 [64-110] months), including 982 300 927 traditional RH, 427 unspecified similar (7 year rate, 93.9%; 95% CI, 91.9%-95.4% 95.3%; 94.0%-96.3%%; P = .07) 94.2%; 90.1%-96.7% 95.4%; 93.6%-96.6%; .15). Risk death either remained after adjusting for covariates alone factors. within subsets by facility type, approach, diagnosis. Adjusted patients balancing (aHR, 1.19; 0.86-1.65; .31) 3-year (98.3%; 97.2%-99.0% 97.6%; 96.6%-98.2%), 5-year (95.9%; 94.3%-97.1% 96.5%; 95.5%-97.3%), 7-year (94.5%; 92.5%-95.9% 95.1%; 93.7%-96.1%), 10-year (89.8%; 86.3%-92.5% 91.7%; 89.4%-93.4%) rates. Sensitivity 2013 documented RMST Conclusions Relevance In this study, supporting use select early-stage carcinoma.