Simplifying surgical criteria for early-stage cervical cancer: prognostic equivalence of total vs. radical hysterectomy in a retrospective SEER cohort analysis
Background:
The prognostic equivalence of total hysterectomy (TH) versus radical hysterectomy (RH) in early-stage cervical cancer (IA2-IB1) with tumor size ≤2 cm remains controversial, particularly regarding the necessity of lymphovascular space invasion (LVSI) assessment. This study evaluates survival outcomes under simplified criteria omitting LVSI and depth of invasion evaluation.
Materials and methods:
This retrospective cohort study analyzed 3002 FIGO IA2-IB1 cervical cancer patients (tumors ≤2 cm) from the SEER database (2004–2019). Inclusion criteria are histologically confirmed adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma; TH/RH with lymphadenectomy/sentinel node biopsy. Outcomes included overall survival (OS) and disease-specific survival (DSS), analyzed via Kaplan–Meier, Cox regression, and propensity score matching (PSM).
Results:
Median follow-up was 73 months. No significant differences were observed in OS (92.3% vs. 92.3%, P = 0.74) and DSS (96.4% vs. 96.6%, P = 0.89) outcomes between RH and TH cohorts, consistent across FIGO stages and adjuvant therapy-without patients. Multivariable analysis confirmed age >49 years (HR = 2.50, 95% CI = 1.91–3.28, P < 0.01), marital status of separated/divorced/widowed (HR = 1.66, 95% CI = 1.20–2.28, P < 0.01), and tumor size 11–20 mm (HR = 1.61, 95% CI = 1.18–2.19, P < 0.01) as independent risk factors in OS. While surgical approach still showed no prognostic significance both in OS (HR = 1.04, 95% CI = 0.79–1.37, P = 0.77) and DSS (HR = 1.01, 95% CI = 0.67–1.53, P = 0.96). Post-PSM analysis (n = 2,715) confirmed survival equivalence (P > 0.05). However, in IB1 adenosquamous/adenocarcinoma patients aged >49 years with tumors 11–20 mm, RH achieved superior DSS (P = 0.01), though OS differences were nonsignificant (P = 0.085). Squamous carcinoma outcomes remained equivalent regardless of surgery (P = 0.43).
Conclusion:
TH achieves survival outcomes comparable to RH in most early-stage cervical cancer patients with tumors ≤2 cm, supporting its application in low-risk populations. However, RH remains preferred for stage IB1 patients with adenocarcinoma or adenosquamous carcinoma aged >49 years and tumors measuring 11–20 mm. Simplified criteria omitting LVSI and stromal depth assessment may enhance accessibility in resource-limited settings without compromising safety.