Health-related quality of life after risk-reducing hysterectomy (PRESCORES): a cross-sectional study

Background Understanding the impact of risk-reducing hysterectomy (RRH) on health-related quality-of-life is essential for informed decision-making around endometrial cancer prevention and has not been previously investigated. This study aimed to estimate health-related utilities in women who received RRH. Methods PRESCORES was a multicentre cross-sectional study (ISRCTN17432105). We invited 4031 UK women ≥18 years with confirmed Lynch Syndrome, without prior gynaecological cancer, to participate between May 2023 and November 2024. The main outcome was a complete-case adjusted mean-difference in EQ-5D utility scores between participants who had undergone RRH or not, and by pre/post-menopausal age groups. Quality-of-life was measured at the time of survey completion, and retrospectively 4 months after surgery in the RRH-group. The Cancer–Worry Scale instrument was also evaluated by RRH group. Sensitivity analysis considered alternative statistical methods, multiple imputation, and restricting analysis to people 35–80 years. Findings Analysis included 1120 participants: 529 had undergone RRH with a median age of 55 years (IQR 48–62), compared with 39 years (33–52) without RRH. The RRH-group was significantly more likely to have had cancer, physical co-morbidities, be parous and used aspirin. Adjusted mean utilities were slightly lower in the RRH than no-RRH group (difference −0.020, 95% CI −0.045 to 0.004; p=0.11), much lower for premenopausal women (−0.041, −0.074 to −0.008), but similar for postmenopausal women (0.003, −0.036 to 0.042). Cancer-Worry-Scale scores were lower in the RRH group (mean-difference 0.48, 95% CI −0.807 to −0.157; p=0.0037). Interpretation was robust to sensitivity analyses. Interpretation Health-related quality-of-life in women with Lynch Syndrome is likely to be lower following RRH in younger, pre-menopausal women. This is relevant for counselling, RRH decision making, and economic evaluations of women with Lynch Syndrome, with increased endometrial cancer risk.