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.