Simple vs Radical Hysterectomy Shows Comparable Survival in Cervical Cancer

Efficacy results from the trial revealed that among patients who received SH, MRH, or RH, the 7-year survival rates were 93.9%, 94.2%, and 95.4%, respectively.

Simple hysterectomy (SH) elicited comparable survival outcomes to both modified radical hysterectomy (MRH) and radical hysterectomy (RH), according to results from the Simple Hysterectomy and Pelvic Node Assessment cohort trial published in JAMA Network Open.1

Efficacy results from the trial revealed that among patients who received SH, MRH, or RH, the 7-year survival rates were 93.9% (95% CI, 91.9%-95.4%), 94.2% (95% CI, 90.1%-96.7%), and 95.4% (95% CI, 93.6%-96.6%; P = .15), respectively. The cumulative 7-year survival among those in the MRH or RH groups, overall, was 95.3% (95% CI, 94.0%-96.3%; P = .07). Additionally, the follow-up duration was similar among both groups, with a median follow-up of 84 months (IQR, 64-109) in the SH group and 85 months (IQR, 63-111) in the cumulative MRH/RH group.

No significant difference was observed in the adjusted risk of all-cause death between the SH and cumulative MRH/RH groups (adjusted HR, 1.21; 95% CI, 0.87-1.67; P = .26). This was additionally observed in pairwise comparisons between SH and RH (adjusted HR, 1.14; 95% CI, 0.78-1.66; P = .50) and between MRH and RH (adjusted HR, 0.96; 95% CI, 0.52-1.77; P = .89). Factors associated with a higher adjusted risk of death included older age at diagnosis (adjusted HR, 1.24; 95% CI, 1.11-1.37; P <.001), a comorbidity score of 1 or greater (adjusted HR, 1.94; 95% CI, 1.31-2.88; P <.001), and grade 3 disease (adjusted HR, 2.61; 95% CI, 1.49-4.57; P <.001).

“Postoperative metrics, including surgical findings, 30-day readmissions, and administration of adjuvant radiation or chemotherapy, were also similar following SH vs MRH or RH. These data … support the use and safety of conservative surgery in patients with low-risk, early-stage cervical carcinoma at Commission on Cancer–accredited facilities,” Christopher M. Tarney, MD, MHA, health science clinical professor of Obstetrics and Urology, chief of Urogynecology in OBGYN, and co-director of the Center for Women’s Pelvic Health at UCLA, wrote in the publication with study coinvestigators. “These findings must be interpreted cautiously given our study design and higher rates of grade 3 disease, lymphovascular space invasion [LVSI], and utilization of adjuvant therapy in our study.”

Investigators in the cohort study evaluated women receiving treatment in US Commission on Cancer-accredited facilities participating in the National Cancer Database who received diagnoses of primary FIGO 2009 stage IA2 or IB1 cervical squamous cell carcinoma (SCC) or adenocarcinoma who underwent SH, MRH, or RH between 2010 and 2017. In total, 2636 women were evaluated, 982 of whom received SH, 300 of whom received MRH, 927 of whom received RH, and 427 of whom received unspecified RH or MRH.

In total, 2289 (86.8%) of patients had stage IB1 disease, with 411 (15.6%) receiving adjuvant therapy following surgery, including 175 (17.8%) of those who underwent SH and 236 (14.3%) of those who underwent MRH or RH. The mean age of patients was 45.4 years (SD, 11.4); 46.6 years (SD, 12.2) in the SH group and 44.7 (SD, 10.9) in the MRH/RH group.

Across groups, the most common comorbidity score was 0 (87.9%), most patients were White (69.8%), and most patients had private insurance (66.8%). The most common histologic subtype was SCC (51.3%), and the most common tumor grade was 2 (44.8%).

The primary end point of the study was overall survival (OS). Secondary end points included postoperative positive surgical margins, LVSI, pathologic lymph node metastases, 30-day hospital readmission rate, and adjuvant treatment administration.

Reference

Tarney CM, Tian C, Randall LM, et al. Long-term survival in patients with low-risk cervical cancer after simple, modified, or radical hysterectomy. JAMA Netw Open. 2025;8(5):e2510717. doi:10.1001/jamanetworkopen.2025.10717