Hormone replacement therapy in endometrial cancer survivors: A retrospective cohort study on recurrence, survival, and quality of life
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Endometrial cancer is the most common gynecologic malignancy in developed countries, often affecting postmenopausal women but also seen in younger patients. Standard treatment includes hysterectomy with bilateral salpingo-oophorectomy, which may lead to menopausal symptoms, especially in premenopausal women. The use of hormone replacement therapy (HRT) in survivors remains controversial due to concerns about stimulating cancer cells. This study aims to evaluate the impact of postoperative HRT on cancer recurrence, survival outcomes, and quality of life in endometrial cancer survivors. This retrospective cohort study analyzed 176 women -between August 2024 and May 2025- with histologically confirmed endometrial adenocarcinoma. Participants were categorized into HRT users (n = 91) and non-users (n = 85) with a median age of 58 and 62 years respectively. Demographic, clinical, and treatment data were compared. Survival analyses were conducted using Kaplan-Meier and Cox regression models. Quality of life was assessed using the MENQOL questionnaire. HRT use was associated with lower recurrence (HR=0.379, p = 0.002) and death hazard (HR=0.248, p = 0.039) rates. Mean recurrence-free survival was longer in the HRT group (53.14 vs 46.28 months, p < 0.001). Improvement in menopausal symptom scores was significantly higher in HRT users (MD= -2.03) compared to the control group (MD= -0.89). No significant increase in adverse cardiovascular or thromboembolic events was observed. Postoperative HRT appears safe and beneficial for selected endometrial cancer survivors, offering improved recurrence-free survival and better menopausal symptom control without increasing serious adverse events. Individualized assessment remains crucial, and further prospective trials are needed to confirm these findings.