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. 2022 Jul 1;31(7):1368-1375. doi: 10.1158/1055-9965.EPI-22-0236.
Endometrial cancer and its treatment may impact urinary system function, but few large-scale studies have examined urinary diagnoses among endometrial cancer survivors. We investigated the risk of several urinary outcomes among older women with endometrial cancer compared with similar women without a cancer history.
Women aged 66+ years with an endometrial cancer diagnosis during 2004-2017 (N = 44,386) and women without a cancer history (N = 221,219) matched 1:5 on exact age, race/ethnicity, and state were identified in the Surveillance, Epidemiology, and End Results-Medicare linked data. ICD-9 and -10 diagnosis codes were used to define urinary outcomes in the Medicare claims. HRs for urinary outcomes were estimated using multivariable Cox proportional hazards regression models.
Relative to women without cancer, endometrial cancer survivors were at an increased risk of several urinary system diagnoses, including lower urinary tract infection [HR, 2.36; 95% confidence interval (CI), 2.32-2.40], urinary calculus (HR, 2.22; 95% CI, 2.13-2.31), renal failure (HR, 2.28; 95% CI, 2.23-2.33), and chronic kidney disease (HR, 1.85; 95% CI, 1.81-1.90). Similar associations were observed in sensitivity analyses limited to 1+ and 5+ years after endometrial cancer diagnosis. Black race, higher comorbidity index, higher stage or grade cancer, non-endometrioid histology, and treatment with chemotherapy and/or radiation were often significant predictors of urinary outcomes among endometrial cancer survivors.
Our results suggest that, among older women, the risk of urinary outcomes is elevated after endometrial cancer.
Monitoring for urinary diseases may be a critical part of long-term survivorship care for older women with an endometrial cancer history.
子宫内膜癌及其治疗可能会影响泌尿系统功能，但很少有大规模研究检查过子宫内膜癌幸存者的泌尿系统诊断。我们调查了与无癌症病史的相似女性相比，年龄较大的子宫内膜癌女性发生几种泌尿系统诊断结果的风险。
我们在监测、流行病学和结果-医疗保险关联数据中确定了在 2004 年至 2017 年期间患有子宫内膜癌的年龄在 66 岁及以上的女性（N=44386）和无癌症病史的女性（N=221219），按照年龄、种族/民族和州精确匹配 1:5。医疗保险索赔中使用 ICD-9 和-10 诊断代码来定义泌尿系统诊断结果。使用多变量 Cox 比例风险回归模型估计泌尿系统诊断结果的 HR。
与无癌症的女性相比，子宫内膜癌幸存者发生几种泌尿系统诊断的风险增加，包括下尿路感染（HR，2.36；95%置信区间[CI]，2.32-2.40）、尿路结石（HR，2.22；95%CI，2.13-2.31）、肾衰竭（HR，2.28；95%CI，2.23-2.33）和慢性肾脏病（HR，1.85；95%CI，1.81-1.90）。在仅限于子宫内膜癌诊断后 1+年和 5+年内的敏感性分析中观察到类似的关联。黑人种族、更高的合并症指数、更高的癌症分期或分级、非子宫内膜样组织学以及化疗和/或放疗治疗往往是子宫内膜癌幸存者泌尿系统诊断结果的重要预测因素。
我们的结果表明，在老年女性中，子宫内膜癌后发生泌尿系统诊断结果的风险增加。
对于有子宫内膜癌病史的老年女性，监测泌尿系统疾病可能是长期生存护理的关键部分。
