Patients with early Endometrial Cancer who don't undergo Hysterectomy have Higher Mortality: Study
Researchers have found in a cohort study that patients with early-stage, low-grade endometrial cancer who did not undergo hysterectomy, particularly those from racial and ethnic minorities or extreme age groups, had a significantly higher risk of death from endometrial cancer, cardiovascular disease, and all causes compared to those who received surgery. The study was published in the journal of O&G by Jhaveri and colleagues.
Hysterectomy remains the standard and most effective treatment for early-stage endometrioid adenocarcinoma. Despite its well-documented benefits, significant disparities in surgical access exist among different demographic groups. The authors utilized a large national cancer database to compare demographic characteristics and patterns of mortality between patients who underwent and did not undergo hysterectomy, thereby providing critical insight into inequities in gynecologic cancer care.
This is a retrospective cohort study, in which 26.5% of the US population was represented through data from the Surveillance, Epidemiology, and End Results (SEER) program. Researchers identified patients aged 18 years or older diagnosed with grade 1, stage IA endometrioid adenocarcinoma between 2010 and 2020.
The main outcome was the prevalence of hysterectomy versus non-hysterectomy treatment. Secondary outcomes included endometrial cancer–specific death, cardiovascular death, and all-cause mortality, stratified by surgical status and age. Demographic differences were compared using comparative statistics, cause-specific mortality was analyzed using Fine-Gray models, and all-cause mortality was assessed using Cox models.
Results
The inclusion and exclusion criteria were met by 27,331 patients. Of these, 26,984 (98.7%) underwent hysterectomy, whereas 347 (1.3%) did not.
Most patients were aged 50-69 years (67.2%) and non-Hispanic White (66.9%).
Patients who did not undergo a hysterectomy were significantly more likely to be:
< 50 years: 54.8% vs 16.8% (P < 0.001)
80 years or older: 7.2% vs 2.6% (P < 0.001)
Hispanic: 24.8% vs 15.6% (P < 0.001)
Non-Hispanic Black: 13.3% vs 5.7% (P < 0.001)
Mortality outcomes were considerably worse in the non-hysterectomy cohort:
Endometrial cancer–specific death: 4.2% vs 1.2%
Cardiovascular death: 7.8% vs 2.1%
All-cause mortality: 23% vs 8.2%
This population-based analysis has shown that racial and ethnic minorities and age extremes had a significantly lower likelihood of undergoing hysterectomy, translating into poorer survival due to endometrial cancer, cardiovascular disease, and all causes. Survival from early-stage endometrioid adenocarcinoma requires equal access to surgical treatment.
Reference:
Jhaveri, Vasanti MD; Meyer, Larissa MD, MPH; Chen, Lu PhD, MPH; Matsuo, Koji MD, PhD; Romero, Roshni P. PharmD; Khor, Victor PhD; Lin, Yvonne G. MD, MS; Wright, Jason D. MD; Huepenbecker, Sarah P. MD, MPH. Hysterectomy Status and Outcomes in Patients With Grade 1, Stage IA Endometrioid Adenocarcinoma. O&G Open 2(6):e132, December 2025. | DOI: 10.1097/og9.0000000000000132
