Comparison of oncologic outcomes between completion hysterectomy and no completion hysterectomy in patients who achieved complete response and completed childbearing after fertility-sparing treatment for early-stage endometrial cancer: Gynecologic Oncology Research Investigators coLLaborAtion study (GORILLA-3001).
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OBJECTIVE: This study evaluated oncological outcomes of completion hysterectomy versus no completion hysterectomy in patients who completed childbearing after achieving complete response (CR) with fertility-sparing treatment (FST) for early-stage endometrial cancer (EC). METHODS: Multicenter data were retrospectively reviewed for patients with presumed stage IA, grade 1 endometrioid EC who gave birth after achieving CR with FST using progestin from 2005 to 2022. Oncologic outcomes were compared between patients who underwent completion hysterectomy and those who did not. RESULTS: Of 338 patients who achieved CR with FST, including those with second or third CR after relapses, 79 (52.7 %, 79/150) became pregnant (seven miscarriages, 72 live births). Completion hysterectomy was performed in 14 of 72 patients after delivery. During a median follow-up time of 61.0 months (range, 13-144) for the entire cohort, recurrence rates were 0 % (0/14) in the hysterectomy group and 22.4 % (13/58) in the non-hysterectomy group (P = 0.055). Progestin re-treatment was administered to 8 of 13 patients who relapsed, and CR was achieved in all. One patient, after a second live birth following re-treatment, was diagnosed with stage IVB extra-uterine disease during follow-up without completion hysterectomy. Five patients underwent hysterectomy immediately after recurrence, and none had extra-uterine disease. In multivariate analysis, recurrence before childbirth (HR 3.8, 95 % CI 1.0-13.3; p < 0.05) was significantly associated with recurrence after pregnancy. CONCLUSION: Completion hysterectomy is associated with improved oncologic outcomes in patients who deliver after FST. Therefore, hysterectomy should be considered for patients who have completed childbearing after FST.