Hormone Therapy for Early Endometrial Cancer Linked to Increased Mortality Risk in Women Approaching 50
New research indicates that while fertility-sparing hormone therapy is a viable option for some women with early-stage endometrial cancer, it carries a significantly elevated risk of death for those aged 40-49 compared to customary hysterectomy. The findings, published online August 28, 2025 in JAMA Oncology, underscore the importance of age-specific risk assessment when considering treatment options for premenopausal patients.
This large cohort study, utilizing data from the American National Cancer Database, examined long-term survival outcomes for women diagnosed with clinical stage I, grade 1-2, endometrioid endometrial carcinoma between 2004 and 2020. Researchers sought to compare survival rates between those initially treated with fertility-sparing hormone therapy and those undergoing primary hysterectomy, while also analyzing trends in hormone therapy utilization.the study included 15,849 women, with 14,662 (92.5%) receiving hysterectomy and 1,187 (7.5%) opting for hormone therapy.
Propensity score matching was employed to ensure a fair comparison between the two treatment groups. Results revealed an overall trend towards lower survival with hormone therapy; 5-year survival rates were 98.5% (95% CI 97.3-99.2) after hysterectomy and 96.8% (95% CI 95.3-97.8) after hormone therapy (HR 1.84; 95% CI 1.06-3.21). However, a crucial age-related distinction emerged. Women under 40 experienced no significant survival difference between the two treatments (HR 1.00; 95% CI 0.50-2.00). Conversely, women aged 40-49 treated with fertility-sparing hormone therapy faced a substantially increased risk of death (HR 4.94; 95% CI 1.89-12.91).
The study also noted a significant increase in the use of hormone therapy over the study period, rising from 5.2% in 2004 to 13.8% in 2020 (p < 0.001).These findings suggest a growing preference for fertility-sparing approaches, but highlight the need for careful patient selection and consideration of age-related risks.
Bron:
Suzuki Y, Huang Y, Xu X, et al.Survival After Fertility-Preserving Hormonal therapy vs Hysterectomy for Early-Stage Endometrial Cancer. JAMA oncol. 2025 aug 28. Online ahead of print.
