Hormone Therapy or Hysterectomy for Endometrial Cancer: Balancing Fertility Preservation Against Survival

Fertility-preserving hormonal therapy is an increasingly accepted option among young women with early-stage endometrial cancer — but what are the long-term effects on survival? Researchers conducted a retrospective observational study of almost 16,000 women (age range, 18–49 years) with stage I, grade 1 or 2 endometrial cancer (stage I is limited to the uterus; grade 1 or 2 is associated with less-aggressive endometrioid histology). Approximately 1200 women received uterus-preserving progestin therapy and 14,700 underwent hysterectomy.

Throughout 5 years' follow-up among patients younger than 40, survival did not differ between those who received progestins (98.2%) or hysterectomy (98.5%). However, among those aged 40 to 49, survival was 90.4% with progestin treatment and 99.4% with hysterectomy — thus, risk for death was significantly higher in association with progestin treatment (hazard ratio, 4.9).