Total Abdominal Hysterectomy Plus Chemo Yields Improved Survival Over Chemo Alone in Newly Diagnosed Uterine Cancer With Distant Metastasis

The addition of total abdominal hysterectomy (TAH) to chemotherapy yielded a significantly better survival vs chemotherapy alone in patients with newly diagnosed uterine cancer with distant organ metastasis, according to a study published in JAMA Network Open.

The median follow-up for the study was 13.4 months, during which TAH plus chemotherapy was associated with improved survival by both univariable (HR, 0.57; 95% CI, 0.53-0.62) and multivariable (HR, 0.59; 95% CI, 0.54-0.65) compared with chemotherapy alone. The propensity score matched analysis highlighted a superior median survival of 19.8 months (Interquartile range [IQR], 18.3-22.3) in the TAH plus chemotherapy arm compared with 11.0 months in the chemotherapy alone arm (IQR, 10.0-12.2; HR, 0.59; 95% CI, 0.53-0.65). The sequential landmark analysis identified a significant improvement in survival for long-term survivors of greater than or equal to 0.5 year (HR, 0.69; 95% CI, 0.63-0.75), greater than or equal to 1 year (HR, 0.78; 95% CI, 0.69-0.88), and greater than or equal to 2 years (HR, 0.73; 95% CI, 0.59-0.91).

“We identified patients who received definitive pelvic radiotherapy and patients who underwent TAH and radiotherapy, in addition to chemotherapy, and both groups of patients also had improved survival over chemotherapy alone, which supports those definitive local therapies may benefit distant metastatic uterine cancer,” wrote investigators of the study.

Notably, the role of TAH as a definitive therapy in uterine cancer with distant metastasis has not been previously established, according to investigators. The analysis is possibly one of the largest reported cohorts of patients with metastatic uterine cancer that has been treated with local therapies, investigators wrote.

The study identified 3197 patients, who had a mean age of 61.9 years who had uterine cancer with distant organ metastasis from the National Cancer Database. Patients included in the study had lung (n = 1544), liver (n = 851), lymph node (n = 497), bone (n = 249), and brain metastases (n = 56). Within this patient population, 1809 patients received chemotherapy alone and 1388 patients received chemotherapy plus TAH. Patients were evaluated for survival following treatment with TAH and chemotherapy vs chemotherapy alone.

Findings from the subgroup analysis indicated that treatment with TAH plus chemotherapy was associated with significantly improved survival compared with chemotherapy alone across all subgroups with the exception of those with leiomyosarcoma (HR, 0.72; 95% CI, 0.51-1.02) and those with metastases of the brain (HR, 0.47; 95% CI, 0.07-3.16).

In total, 79% (n = 1091) of patients who underwent TAH followed by chemotherapy had significantly better median survival (18.8 months; IQR, 17.0-20.4) compared with those who received chemotherapy alone (10.3 months; IQR, 9.7-11.2).

Additionally, 228 patients who received definitive pelvic radiotherapy (HR, 0.60; 95% CI, 0.51-0.71), and 143 patients who underwent TAH and radiotherapy in addition to chemotherapy (HR, 0.34; 95% CI, 0.26-0.44) achieved significantly improved survival over those who received chemotherapy alone.

Reference:

Wang Y, Tillmanns T, VanderWalde N, et al. Comparison of chemotherapy vs chemotherapy plus total hysterectomy for women with uterine cancer with distant organ metastasis. JAMA Netw Open. 2021;4(7):e2118603. doi:10.1001/jamanetworkopen.2021.18603