Hysterectomy Status and Outcomes in Patients With Grade 1, Stage IA Endometrioid Adenocarcinoma.

OBJECTIVE: To compare clinicodemographic factors and outcomes of patients with grade 1, stage IA endometrioid adenocarcinoma who did and did not undergo hysterectomy. METHODS: This is a retrospective cohort study using data from the SEER (Surveillance, Epidemiology and End Results) registry program, which collates population-based cancer registry information from 26.5% of the U.S. population. The SEER database identified patients aged 18 years or older with grade 1, stage IA endometroid adenocarcinoma from 2010 to 2020. The primary outcome was prevalence of patients who did and did not undergo hysterectomy. Secondary outcomes included endometrial and cardiovascular-specific death and all-cause mortality by surgical status and age. Descriptive and comparative statistics between the hysterectomy and nonhysterectomy cohorts were completed. Survival between surgical cohorts was compared using Fine-Gray models for cause-specific death (endometrial cancer, cardiovascular) and Cox models for all-cause mortality. RESULTS: Of 27,331 patients, 26,984 (98.7%) had hysterectomy and 347 (1.3%) did not. Most patients were between age 50 and 69 years (67.2%) and were non-Hispanic White (66.9%). Patients without hysterectomy were more likely to be younger than age 50 (54.8% vs 16.8%, P<.001), 80 years or older (7.2% vs 2.6%, P<.001), Hispanic (24.8% vs 15.6%, P<.001), and non-Hispanic Black (13.3% vs 5.7%, P<.001). The nonhysterectomy cohort had a higher cumulative incidence of death attributable to endometrial cancer (4.2% vs 1.2%), cardiovascular disease (7.8% vs 2.1%), and all-cause (23% vs 8.2%) mortality compared with the hysterectomy cohort. CONCLUSION: Patients from racial and ethnic minority groups and with extremes of age were less likely to undergo hysterectomy. Deaths resulting from endometrial cancer and cardiovascular disease and all-cause mortality were higher in patients who did not undergo hysterectomy.