Hysterectomy or/and lymphadenectomy for the survival of patients with primary endometrial cancer: a cohort study using the SEER database

In order to provide a clinical reference for endometrial cancer treatment, this retrospective cohort study aimed to assess and compare the survival of endometrial cancer patients undergoing hysterectomy versus lymphadenectomy and hysterectomy combined with lymphadenectomy. The Surveillance, Epidemiology, and End Results (SEER) database provided data on patients with primary endometrial cancer enrolled between 1975 and 2016. The longest follow-up time was ten years, and the median follow-up time was 51.00 months. The outcomes were overall survival (OS) and cancer-specificsurvival (CSS). COX models were constructed to assess the relationship between the three surgical methods and OS or CSS. Subgroup analyses were conducted based on American Joint Committee on Cancer (AJCC) stage and menopausal status. Totally 134,597 patients were included. In stage IV, the lymphadenectomy group had significantly worse OS than the hysterectomy group (HR = 1.330, 95%CI = 1.101-1.606). The hysterectomy combined with lymphadenectomy group had similar OS to the hysterectomy group (HR = 1.183, 95%CI = 0.996-1.405). Regarding CSS, no significant differences were found between the hysterectomy and lymphadenectomy groups (HR = 1.267, 95%CI = 0.996-1.610), and between the hysterectomy and hysterectomy combined with lymphadenectomy groups (HR = 1.186, 95%CI = 0.953-1.476) in stage IV. For postmenopausal women, lymphadenectomy (HR = 1.655, 95%CI = 1.495-1.831) and hysterectomy combined with lymphadenectomy (HR = 1.129, 95%CI = 1.038-1.228) were associated with significantly decreased OSthan hysterectomy. For CSS among postmenopausal women, significant declines inCSS were found in the lymphadenectomy (HR = 2.264, 95%CI = 1.957-2.619) and hysterectomy combined with lymphadenectomy (HR = 1.419, 95%CI = 1.260-1.599) groups versus the hysterectomy group. Hysterectomy may serve as a decision-making reference for clinicians in treating patients in stage IV or after menopause, combined with clinical experience and patients' wishes.