Impact of bilateral oophorectomy on survival among patients undergoing radical hysterectomy for cervical adenocarcinoma: a National Cancer Database analysis.
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OBJECTIVE: The role of bilateral salpingo-oophorectomy at the time of radical hysterectomy for cervical adenocarcinoma remains controversial. We aim to study the impact of bilateral salpingo-oophorectomy on overall survival of women undergoing radical hysterectomy for treatment of cervical cancer, specifically, with adenocarcinoma histology. METHODS: We conducted a retrospective analysis of the National Cancer Database during 2004-2022. We included women aged 18 to 45 years, with a diagnosis of cervical adenocarcinoma, who underwent radical hysterectomy with or without bilateral salpingo-oophorectomy. Clinicopathologic characteristics, treatment patterns, and outcomes were compared. Kaplan-Meier survival estimates and Cox proportional hazards models were used to evaluate overall survival. RESULTS: A total of 6061 patients with adenocarcinoma were identified: 4606 (76.0%) underwent hysterectomy with bilateral salpingo-oophorectomy and 1455 (24.0%) without. Patients in the bilateral salpingo-oophorectomy group were older (median 39 vs 37 years, p < .001). Adjuvant chemotherapy (871 [19.2%] vs 194 [13.5%]) and radiotherapy (1085 [24.3%] vs 247 [17.9%]) were more frequently used in the bilateral salpingo-oophorectomy group (p < .001). On unadjusted analysis, bilateral salpingo-oophorectomy was associated with inferior survival in adenocarcinoma 83.9% versus 87.0% alive at 190 months (log-rank p = .022). After adjustment for age, race, adjuvant therapy, and disease stage, bilateral salpingo-oophorectomy was not associated with survival (adjusted hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.78 to 1.26). For the whole cohort, including adenocarcinoma and squamous cell carcinoma, the Cox regression concluded that bilateral salpingo-oophorectomy is associated with worse survival (adjusted HR 1.19, 95% CI 1.04 to 1.36). For adenocarcinoma stage I disease with no adjuvant radiotherapy or chemotherapy (n = 3893), overall survival was similar between groups (log-rank p = .758). CONCLUSIONS: Bilateral salpingo-oophorectomy does not confer a survival advantage and may worsen long-term survival, particularly, in squamous cell carcinoma. Ovarian preservation is oncologically safe in early-stage cervical cancer, including adenocarcinoma, and should be routinely considered for pre-menopausal women without evidence of ovarian involvement.