Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2021 Jun;30(6):1079-1088. doi: 10.1158/1055-9965.EPI-20-1631. Epub 2021 Mar 18.
We investigated excess mortality after endometrial cancer using conditional relative survival estimates and standardized mortality ratios (SMR).
Women diagnosed with endometrial cancer during 2000-2017 ( = 183,153) were identified in the Surveillance Epidemiology and End Results database. SMRs were calculated as observed deaths among endometrial cancer survivors over expected deaths among demographically similar women in the general U.S.
Five-year relative survival was estimated at diagnosis and each additional year survived up to 12 years post-diagnosis, conditional on survival up to that year.
For the full cohort, 5-year relative survival was 87.7%, 96.2%, and 97.1% at 1, 5, and 10 years post-diagnosis, respectively. Conditional 5-year relative survival first exceeded 95%, reflecting minimal excess mortality compared with the general population, at 4 years post-diagnosis overall. However, in subgroup analyses, conditional relative survival remained lower for Black women (vs. White) and for those with regional/distant stage disease (vs. localized) throughout the study period. The overall SMR for all-cause mortality decreased from 5.90 [95% confidence interval (CI), 5.81-5.99] in the first year after diagnosis to 1.16 (95% CI, 1.13-1.19) at 10+ years; SMRs were consistently higher for non-White women and for those with higher stage or grade disease.
Overall, endometrial cancer survivors had only a small survival deficit beyond 4 years post-diagnosis. However, excess mortality was greater in magnitude and persisted longer into survivorship for Black women and for those with more advanced disease.
Strategies to mitigate disparities in mortality after endometrial cancer will be needed as the number of survivors continues to increase.
我们通过条件相对生存率估计和标准化死亡率比（SMR）来研究子宫内膜癌的超额死亡率。
在美国监测、流行病学和最终结果数据库中，我们确定了 2000 年至 2017 年期间被诊断患有子宫内膜癌的女性（n=183153）。SMR 是通过观察子宫内膜癌幸存者在预期中死于与美国一般人群在人口统计学上相似的女性的预期死亡人数来计算的。
在诊断时和诊断后额外存活的每一年，我们都估计了 5 年相对生存率，条件是当年存活。
对于整个队列，5 年相对生存率分别为诊断后 1、5 和 10 年的 87.7%、96.2%和 97.1%。5 年条件相对生存率首次超过 95%，反映出与一般人群相比，整体诊断后 4 年的超额死亡率最小。然而，在亚组分析中，在整个研究期间，黑人女性（与白人女性相比）和局部疾病（与区域/远处疾病相比）的条件相对生存率仍然较低。所有原因死亡率的总 SMR 从诊断后第一年的 5.90（95%置信区间[CI]，5.81-5.99）下降到 10 年以上的 1.16（95%CI，1.13-1.19）；非白人女性和疾病分期或分级较高的女性的 SMR 一直较高。
总体而言，子宫内膜癌幸存者在诊断后 4 年以上仅有很小的生存缺陷。然而，对于黑人女性和疾病程度较高的女性，超额死亡率的幅度更大，并且在生存期间持续时间更长。
随着幸存者人数的不断增加，将需要采取策略来减轻子宫内膜癌后死亡率的差异。
