Total Abdominal Hysterectomy May Boost Survival For Uterine Cancer With Distant Organ Metastases

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: A review of over 3000 patients suggests that receipt of total abdominal hysterectomy (TAH) may confer a significant survival benefit in women undergoing chemotherapy for uterine cancer with distant organ metastases.

Recognising that TAH has been shown to improve survival in uterine cancer patients with abdominal or pelvic metastases, a team of researchers from the West Cancer Center and Research Institute in Memphis, Tennessee, USA, investigated the impact of TAH in patients with distant disease.

Yuefeng Wang and colleagues collated US National Cancer Database records for 3197 such patients treated between 2010 and 2014. The most common metastatic sites were the lung (48.3%) and the liver (26.6%), followed by the lymph nodes (15.5%), bone (7.8%) and brain (1.8%).

In all, 1388 patients underwent TAH before or after chemotherapy, while 1809 patients received chemotherapy only; 143 patients had definitive pelvic radiotherapy with TAH and chemotherapy and 228 patients had definitive pelvic radiotherapy and chemotherapy only.

After a median 13.4 months of follow-up, receipt of TAH plus chemotherapy was associated with a significant overall survival benefit compared with chemotherapy alone, with a hazard ratio (HR) for death of 0.59 in multivariable analysis adjusting for 16 variables including age, year of diagnosis, tumour characteristics and comorbidities.

Propensity score-matched analysis confirmed that TAH plus chemotherapy was associated with a significant survival gain compared with chemotherapy alone, with a median duration of 19.8 versus 11.0 months and a HR of 0.59.

And sequential landmark analysis designed to account for whether patients responded to treatment or not showed that use of TAH plus chemotherapy significantly improved survival versus chemotherapy alone whether patients had survived for at least 0.5 years, at least 1 year or at least 2 years, with HRs of 0.69, 0.78 and 0.73, respectively.

This “suggests that the benefit of TAH in the study is not just associated with bias”, explain Yuefeng Wang and co-authors in their research letter to JAMA Network Open.

Among 1388 patients who received TAH, 79% underwent the surgery before chemotherapy and these women had a significant survival gain compared with women who underwent chemotherapy without TAH, at a median of 18.8 versus 10.3 months.

This finding “helped to rule out the selection bias that TAH was only delivered to patients who had good response from neoadjuvant chemotherapy”, the authors remark.

The researchers also found that patients who received definitive pelvic radiotherapy and chemotherapy, with or without TAH, had better survival than those who received only chemotherapy (HRs=0.60 and 0.34, respectively).

Finally, further investigation indicated that all patient subgroups derived a survival benefit from use of TAH with chemotherapy, although the association did not reach statistical significance for patients with leiomyosarcoma or brain metastases.

Yuefeng Wang et al note that their study was limited by National Cancer Database records and therefore lacked information on number of metastases, use of specific chemotherapy or salvage treatments and other important factors.

Nevertheless, they describe their findings as “intriguing” and conclude that “[r]andomized clinical trials to evaluate the effect of TAH on distant metastatic uterine cancer appear to be warranted.”

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