Metastasis-Directed Therapy Versus Systemic Therapy in Oligometastatic Endometrial Carcinoma Recurrence: A Population-Based Registry Analysis

Background/Objectives: Comparative data on metastasis-directed therapy (MDT) versus systemic therapy in oligometastatic endometrial carcinoma (EC) recurrence are lacking. Methods: In this retrospective population-based registry study (Tumor Register Saxony-Anhalt, 2000–2025), we included 153 treated patients with distant-only oligometastatic EC recurrence (≤2 anatomical sites) after curative-intent primary treatment. Overall survival (OS) was compared between a strategy including MDT (n = 97) and systemic therapy alone (n = 56) using inverse probability of treatment weighting (IPTW)-adjusted Cox regression. Subgroup, sensitivity and competing risks analyses were exploratory. Results: In the IPTW analysis (n = 145 with complete data), OS did not differ significantly between MDT and systemic therapy (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.61–1.35; p = 0.622), consistent across sensitivity analyses. In exploratory subgroup analysis, MDT was associated with better OS in high-grade tumors (n = 51; HR 0.27, 95% CI 0.12–0.59; p = 0.001; Holm-adjusted p = 0.013), but not in low-grade tumors (HR 1.29; p = 0.339). Conclusions: MDT and systemic therapy showed no statistically significant survival difference in unselected oligometastatic EC recurrence; the confidence interval cannot exclude clinically relevant benefit or harm, supporting individualized decisions. The high-grade finding is hypothesis-generating and warrants prospective validation.