Impact of Conservative Managements in Young Women With Grade 2 or 3 Endometrial Adenocarcinoma Confined to the Endometrium

Objectives: The aim of this study was to evaluate the impact of ovarian and/or uterine preservation in young patients with grade 2 or 3 endometrial adenocarcinoma confined to the endometrium. Methods/Materials: A population-based analysis was conducted. The SEER' 17 Database was used to identify women younger than 45 years with grade 2 or 3 endometrial adenocarcinoma confined to the endometrium from 1983 to 2012. A cohort of 1106 women was included: 849 underwent hysterectomy with bilateral adnexectomy, 96 underwent hysterectomy with ovarian preservation, and 49 underwent uterine preservation. The demographics and survival rates according to the type of treatment administered were compared. Results: The 5-year overall survival probabilities were 94.8% (95% confidence interval [CI], 92.8-96.2), 93.8% (95% CI, 85.8-97.4), and 78.2% (95% CI, 62.1-88.1) for patients who underwent hysterectomy with bilateral adnexectomy, ovarian preservation, and uterine preservation, respectively (P < 0.001). The 5-year cancer-related survival probabilities were 99.3% (95% CI, 98.6-99.9), 98.9% (95% CI, 96.9-99.9), and 86.2% (95% CI, 75.7-98.2) for patients who underwent hysterectomy with bilateral adnexectomy, ovarian preservation, and uterine preservation, respectively (P < 0.001). Patients who received uterine conservation had lower disease-specific (adjusted hazard ratio [aHR], 15.8 95% CI, 5.5-45.2) and overall survival probabilities (aHR, 6.6; 95% CI, 3.3-13.4) than did patients who underwent hysterectomy with or without oophorectomy. Ovarian conservation was not associated with decreased disease-specific (aHR, 1.45; 95% CI, 0.31-6.71) or overall (aHR, 0.58; 95% CI, 0.17-1.90) survival. Conclusions: Ovarian preservation has no impact on survival probability in patients with grade 2 or 3 endometrial cancer confined to the endometrium. On the contrary, physicians and patients should be aware of the worse prognosis associated with uterine preservation.