Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
JAMA Oncol. 2022 Jun 1;8(6):895-903. doi: 10.1001/jamaoncol.2022.0009.
Uterine cancer incidence has been increasing, particularly rates of aggressive, nonendometrioid subtypes, which are disproportionately higher among non-Hispanic Black women. The association of subtype-specific trends with uterine cancer mortality and with the role of tumor subtype and stage at diagnosis with racial disparities in uterine cancer deaths at the population-based level are not known.
To estimate histologic subtype- and stage-specific uterine cancer mortality rates by race and ethnicity, corrected for hysterectomy.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the US Surveillance, Epidemiology, and End Results-18 Incidence-Based Mortality database, representing approximately 26% of the US population and including deaths that occurred from 2000 to 2017. Hysterectomy correction was based on hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. Uncorrected and corrected rates associated with uterine corpus cancer cases diagnosed between 2000 and 2017 and uterine corpus cancer deaths occurring between 2010 and 2017 were age-adjusted to the 2000 US standard population and are expressed per 100 000 person-years, and annual percent changes in rates were calculated using log-linear regression. Data analysis was performed from March 10 to May 20, 2021.
Tumor histologic subtype, cancer stage at diagnosis, and race and ethnicity.
Among 208 587 women diagnosed with uterine cancer during 2000-2017 (15 983 [7.7%] were Asian; 20 302 [9.7%] Black; 23 096 [11.1%] Hispanic; and 149 206 [71.5%] White individuals), there were 16 797 uterine cancer deaths between 2010 and 2017, corresponding to a hysterectomy-corrected mortality rate of 15.7 per 100 000 person-years. Hysterectomy-corrected rates were highest among Black women, overall, by histologic subtype and stage at diagnosis. Among all women, uterine corpus cancer mortality rates increased significantly by 1.8% (95% CI, 1.5%-2.9%) per year from 2010 to 2017, as did rates of nonendometrioid carcinomas (2.7%; 95% CI, 1.8%-3.6%), with increases occurring in Asian (3.4%; 95% CI, 0.3%-6.6%), Black (3.5%; 95% CI, 2.2%-4.9%), Hispanic (6.7%; 95% CI, 1.9%-11.8%), and White women (1.5%; 95% CI, 0.6%-2.4%). In contrast, endometrioid carcinoma mortality rates remained stable.
The findings of this cohort study suggest a significant increase of nonendometrioid uterine carcinoma mortality rates, aligning with recent incidence trends. The factors associated with these trends are not well understood and require more investigation of possible mechanisms. Despite stable incidence rates, endometrioid cancer mortality rates have not decreased over the past decade at the population level, suggesting limited progress in treatment for these cancers. The substantial disparities in uterine corpus cancer mortality rates among non-Hispanic Black women cannot be fully explained by subtype distribution and stage at diagnosis.
子宫癌的发病率一直在上升，尤其是侵袭性、非子宫内膜样亚型的发病率更高，而这些亚型在非西班牙裔黑人女性中不成比例地更高。特定亚型趋势与子宫癌死亡率之间的关联，以及肿瘤亚型和诊断时的分期在人群水平上与子宫癌死亡的种族差异之间的关系尚不清楚。
根据种族和族裔，估计特定组织学亚型和分期的子宫癌死亡率，并校正子宫切除术。
设计、地点和参与者：本队列研究使用了美国监测、流行病学和最终结果-18 基于发病率的死亡率数据库，该数据库代表了大约 26%的美国人口，并包括 2000 年至 2017 年发生的死亡。基于行为风险因素监测系统的子宫切除术流行率数据进行了子宫切除术校正。与 2000 年至 2017 年诊断的子宫体癌病例和 2010 年至 2017 年发生的子宫体癌死亡相关的未经校正和校正后的比率按年龄调整为 2000 年美国标准人口，并以每 100000 人年表示，使用对数线性回归计算了比率的年变化百分比。数据分析于 2021 年 3 月 10 日至 5 月 20 日进行。
肿瘤组织学亚型、诊断时的癌症分期以及种族和族裔。
在 2000-2017 年期间诊断出患有子宫癌的 208587 名女性中（15983 [7.7%]为亚洲人；20302 [9.7%]为黑人；23096 [11.1%]为西班牙裔；和 149206 [71.5%]为白人个体），2010 年至 2017 年期间发生了 16797 例子宫癌死亡，对应的校正子宫切除术死亡率为 15.7/100000 人年。总体而言，黑人女性的校正子宫切除术死亡率最高，无论是根据组织学亚型还是诊断时的分期。在所有女性中，2010 年至 2017 年期间，子宫体癌死亡率每年显著增加 1.8%（95%CI，1.5%-2.9%），非子宫内膜样癌（2.7%；95%CI，1.8%-3.6%）的比率也有所增加，其中亚洲女性（3.4%；95%CI，0.3%-6.6%）、黑人女性（3.5%；95%CI，2.2%-4.9%）、西班牙裔女性（6.7%；95%CI，1.9%-11.8%）和白人女性（1.5%；95%CI，0.6%-2.4%）的死亡率也有所增加。相比之下，子宫内膜样癌的死亡率保持稳定。
本队列研究的结果表明，非子宫内膜样子宫癌的死亡率显著增加，与最近的发病率趋势一致。与这些趋势相关的因素尚不清楚，需要进一步研究可能的机制。尽管发病率保持稳定，但过去十年中，人群水平上的子宫内膜癌死亡率并没有下降，这表明在这些癌症的治疗方面进展有限。非西班牙裔黑人女性中子宫体癌死亡率的巨大差异不能完全用亚型分布和诊断时的分期来解释。
