Comparative outcomes of simple versus radical hysterectomy in patients with and without very low-risk early-stage cervical cancer: An exploratory analysis from the Gynecologic Cancer Intergroup/Canadian Cancer Trials Group CX.5/SHAPE trial. - 2026
Comparative outcomes of simple versus radical hysterectomy in patients with and without very low-risk early-stage cervical cancer: An exploratory analysis from the Gynecologic Cancer Intergroup/Canadian Cancer Trials Group CX.5/SHAPE trial.
[en] [en] OBJECTIVE: To compare oncologic outcomes and perioperative morbidity between simple hysterectomy (SH) and radical hysterectomy (RH) in patients with and without very low-risk early-stage cervical cancer from the phase III Simple Hysterectomy And PElvic node assessment (SHAPE) trial.
METHODS: Patients who underwent SH or RH in the SHAPE trial were classified into the Conservative SHAPE group (very low-risk), meeting criteria similar to the ConCerv trial, and the Liberal SHAPE group (without very low-risk), including everyone else. Between the SH and RH arms in each group, survival outcomes, including recurrence-free survival (RFS) and overall survival (OS), and intraoperative and postoperative morbidities were compared. Factors associated with recurrence and mortality rates were also investigated.
RESULTS: In the Conservative SHAPE group (n = 107), no recurrence was observed in either SH or RH arms, and only one non-cancer-related death in the RH arm during a median follow-up of 4.5 years. In the Liberal SHAPE group (n = 575), the SH arm showed similar 3-year pelvic RFS (96.9 % vs. 97.4 %; HR, 1.15; 95 % CI, 0.49-2.70), extrapelvic RFS (97.7 % vs. 99.6 %; HR, 3.64; 95 % CI, 0.76-17.5), overall RFS (95.4 % vs. 97.4 %; HR, 1.56; 95 % CI, 0.70-3.48), and OS (98.9 % vs. 99.3 %; HR, 1.21; 95 % CI, 0.41-3.59), compared with the RH arm. In multivariate analyses, SH was not associated with recurrence and mortality rates, while absence of residual disease in the hysterectomy specimen was associated with lower recurrence. In both groups, SH was associated with a lower risk of urinary retention and incontinence.
CONCLUSION: There were similar recurrence and survival outcomes but less morbidity from simple hysterectomy compared to radical hysterectomy in patients with and without very low-risk early-stage cervical cancer from the SHAPE trial.
Disciplines :
Oncology Reproductive medicine (gynecology, andrology, obstetrics) Surgery
Author, co-author :
Kim, Se Ik; Seoul National University College of Medicine, Seoul, Republic of Korea
Kim, Jae-Weon; Seoul National University College of Medicine, Seoul, Republic of Korea
Kwon, Janice S; University of British Columbia, Vancouver, Canada. Electronic address: janice.kwon@vch.ca
Ferguson, Sarah E; Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
Sebastianelli, Alexandra; Centre Hospitalier de l'Université de Montréal, Montréal, Canada
Bessette, Paul; Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
Mahner, Sven; Ludwig Maximilians University Munich, Munich, Germany
Gauthier, Tristan; Centre Hospitalier Universitaire de Limoges, Limoges, France
de Kroon, Cor; Leiden University Medical Center, Leiden, the Netherlands
van Driel, Willemien; Netherlands Cancer Institute, Amsterdam, the Netherlands
Williamson, Karin; Nottingham University Hospital, Nottingham, United Kingdom
Goffin, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie-obstétrique, partim Gynécologie
Polterauer, Stephan; Medical University of Vienna, Vienna, Austria
Eyjólfsdóttir, Brynhildur; Oslo University Hospital, Oslo, Norway
Lee, Jung-Yun; Yonsei University College of Medicine, Seoul, Republic of Korea
Maguire, Patrick J; St. James's Cancer Institute, Dublin, Ireland
Juhasz-Böss, Ingolf; University of Freiburg, Freiburg, Germany
Lim, Hyunji; Seoul National University College of Medicine, Seoul, Republic of Korea
Seol, Aeran; Seoul National University College of Medicine, Seoul, Republic of Korea
Comparative outcomes of simple versus radical hysterectomy in patients with and without very low-risk early-stage cervical cancer: An exploratory analysis from the Gynecologic Cancer Intergroup/Canadian Cancer Trials Group CX.5/SHAPE trial.
We would like to acknowledge the support of the Gynecologic Cancer InterGroup which facilitated the participation of the many international cooperative groups that made the SHAPE trial a success, and the Canadian Institutes of Health Research which provided peer-reviewed grant funding for the SHAPE trial.
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