Comparative Survival Outcomes of Total Hysterectomy Versus Radical Hysterectomy in Gastric-Type Endocervical Adenocarcinoma: A SEER Database Analysis
This study aims to assess the efficacy of total hysterectomy versus radical hysterectomy in the treatment of gastric-type endocervical adenocarcinoma (GEA). Patients diagnosed with GEA from 2001 to 2021 were derived from the Surveillance, Epidemiology, and End Results database. Clinicodemographic characteristics, tumour clinicopathological features, and survival outcomes (including vital status and duration of follow-up) of these patients were collected. Kaplan-Meier survival curves were generated to estimate survival probabilities, with between-group differences assessed using log-rank tests for statistical significance. Overall, 114 patients undergoing total hysterectomy, and 129 patients undergoing radical hysterectomy were included for survival analysis. No statistically significant differences in overall survival (OS) were observed between surgical approaches, either in the entire cohort (P = 0.0594) or the International Federation of Gynecology and Obstetrics stage I-IIA subcohort (P = 0.0777). Adjuvant therapy (radiotherapy and/or chemotherapy) was administered to 52.6% (60/114) of patients in the total hysterectomy group and 42.6% (55/129) in the radical hysterectomy group. However, there was no statistically significant difference in OS between the total hysterectomy and radical hysterectomy groups among patients who received adjuvant therapy, and similar results were also found in the subgroup of patients with International Federation of Gynecology and Obstetrics stage Ⅰ-ⅡA disease. Notably, adjuvant therapies failed to demonstrate significant OS benefits in either surgical group for stage I-IIA disease. Total hysterectomy demonstrated comparable survival outcomes to radical hysterectomy in patients with GEA. These findings suggest that less extensive surgery may represent a viable treatment alternative for early-stage disease.