Kaur Anahat, Wang Shuai, Kumar Abhishek
Department of Hematology and Medical Oncology, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY, United States of America.
Department of Hematology and Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States of America.
Gynecol Oncol. 2023 Mar;170:266-272. doi: 10.1016/j.ygyno.2023.01.032. Epub 2023 Feb 2.
We assessed potential years of life lost (PYLL) in women secondary to gynecologic cancers (cervical, uterine, ovarian, vaginal, vulvar, and other) in the United States from 1975 to 2017 using SEER database. We also highlight racial disparities and economic costs of mortality from gynecologic malignancies.
PYLL up to and including age 75 years were calculated [75 - (age at diagnosis + overall survival)] after stratifying for tumor site. Subgroup comparison was done using nonparametric method Kruskal-Wallis H with post-hoc analysis. Linear regression model was used to calculate every five-year incremental trends. Productivity losses were calculated using mortality data multiplied by age-adjusted estimated total lifetime productivity.
Total 304,995 patients were included with 1,472,152.67 PYLL from 1975 to 2017. Median PYLL for cervical cancer (12.58 years) was higher than other gynecologic malignancies (0.83, 6.00, 0.67 and - 0.25 years respectively for uterine, ovarian, vaginal and vulvar cancers). The median PYLL for Non-Hispanic White (NHW) population was lower than women from other racial groups for uterine, ovarian and vulvar cancers. From 1975 to 2017, median PYLL trend in the entire cohort showed a steady increment (p < 0.001, B1 = 1.65 years). Most rapid rise was noted in cervical cancer (p < 0.001, B1 = 2.68 years) and Hispanic population (p < 0.001, B1 = 1.92). Total productivity loss was $79 billion during 1975-2017 with maximum loss seen in uterine cancer and NHW population.
Ours is the first study to analyze PYLL in gynecologic malignancies and estimate productivity losses due to premature deaths. Data shows a clear trend pointing towards racial and ethnic disparities.
我们利用监测、流行病学和最终结果（SEER）数据库评估了1975年至2017年美国因妇科癌症（宫颈癌、子宫癌、卵巢癌、阴道癌、外阴癌及其他）导致女性潜在寿命损失年数（PYLL）。我们还强调了妇科恶性肿瘤死亡率的种族差异和经济成本。
在对肿瘤部位进行分层后，计算至75岁（包括75岁）的PYLL [75 - （诊断时年龄 + 总生存期）]。亚组比较采用非参数方法Kruskal-Wallis H检验及事后分析。使用线性回归模型计算每五年的增量趋势。生产力损失通过死亡率数据乘以年龄调整后的估计终生总生产力来计算。
1975年至2017年共纳入304,995例患者，PYLL总计1,472,152.67年。宫颈癌的中位PYLL（12.58年）高于其他妇科恶性肿瘤（子宫癌、卵巢癌、阴道癌和外阴癌的中位PYLL分别为0.83年、6.00年、0.67年和 - 0.25年）。非西班牙裔白人（NHW）人群子宫癌、卵巢癌和外阴癌的中位PYLL低于其他种族女性。1975年至2017年，整个队列的中位PYLL趋势呈稳步上升（p < 0.001，B1 = 1.65年）。宫颈癌（p < 0.001，B1 = 2.68年）和西班牙裔人群（p < 0.001，B1 = 1.92年）的上升最为迅速。1975年至2017年期间，总生产力损失为790亿美元，子宫癌和NHW人群的损失最大。
我们的研究是首次分析妇科恶性肿瘤的PYLL并估计过早死亡导致的生产力损失。数据显示出明显的种族和民族差异趋势。
