Cuello Mauricio A, Gomez-Valenzuela Fernán, Wichmann Ignacio, Olawaiye Alexander B
Department of Gynecology, School of Medicine, Pontificia Universidad Católica de Chile (PUC), Santiago, Chile.
Gynecologic Oncology Unit, Hospital Clínico Universidad Católica, UC-Christus Health Network, Santiago, Chile.
Int J Gynaecol Obstet. 2025 Sep;171 Suppl 1:147-165. doi: 10.1002/ijgo.70279.
Gynecologic cancers, including cervical, ovarian, and endometrial cancers, remain a significant global health challenge. In 2022, 9 175 141 new cancer cases were reported among females, with 1 473 427 (16.1%) attributed to gynecologic cancers, reflecting an incidence rate of 30.4 per 100 000. These cancers were responsible for 680 372 deaths, representing 15.9% of total female cancer mortality at a rate of 17.3 per 100 000. Identifying the drivers of incidence and mortality is critical for addressing disparities and advancing the United Nations Sustainable Development Goals (SDGs), particularly those targeting health equity and gender equality.
To identify and analyze the socioeconomic, healthcare, lifestyle, and environmental determinants driving gynecologic cancer incidence and mortality globally. The study leveraged a cluster-based approach across 68 countries, representing 34.9% of global nations and spanning diverse geographic and economic contexts.
Eighty-seven variables were analyzed using Principal Component Analysis (PCA), consolidating them into 17 key components that explained 74.4% of the total variance. These components informed a hierarchical clustering process that grouped countries into four profiles based on shared characteristics. Cluster-specific backward regression models examined the influence of these components on standardized incidence and mortality rates (Adjusted Rate Standardized, ARS). Monte Carlo simulations validated projections, providing robust insights into disparities.
The study revealed significant cluster-specific variability in factors influencing gynecologic cancer outcomes. Cluster 1 excelled in lifestyle-driven cancer prevention, whereas systemic barriers in Cluster 4 necessitate urgent healthcare investment and policy reform. Intermediate clusters exhibited variability influenced by social stability, environmental health, and healthcare infrastructure. The analysis underscored disparities in key predictors such as HPV vaccination coverage, healthcare expenditure, public health policies, and access to preventive services.
This study highlights the importance of tailored, cluster-specific strategies to reduce disparities in gynecologic cancer outcomes. Interventions should prioritize equitable access to preventive care, lifestyle modifications, and healthcare investments, particularly in resource-constrained regions. The findings align with SDG targets on health and well-being (SDG 3) and gender equality (SDG 5), offering actionable insights to accelerate progress toward WHO's 90-70-90 goals and the elimination of cervical cancer as a public health threat.
妇科癌症，包括宫颈癌、卵巢癌和子宫内膜癌，仍然是一项重大的全球健康挑战。2022年，女性中报告了9175141例新发癌症病例，其中1473427例（16.1%）归因于妇科癌症，发病率为每10万人30.4例。这些癌症导致680372人死亡，占女性癌症总死亡率的15.9%，死亡率为每10万人17.3例。确定发病率和死亡率的驱动因素对于解决差异和推进联合国可持续发展目标（SDG）至关重要，特别是那些针对健康公平和性别平等的目标。
确定并分析推动全球妇科癌症发病率和死亡率的社会经济、医疗保健、生活方式和环境决定因素。该研究采用了基于聚类的方法，涵盖68个国家，占全球国家的34.9%，跨越不同的地理和经济背景。
使用主成分分析（PCA）分析了87个变量，将它们整合为17个关键成分，这些成分解释了总方差的74.4%。这些成分用于指导层次聚类过程，根据共同特征将国家分为四类。特定聚类的向后回归模型研究了这些成分对标准化发病率和死亡率（调整率标准化，ARS）的影响。蒙特卡罗模拟验证了预测结果，为差异提供了有力的见解。
该研究揭示了影响妇科癌症结果的因素在特定聚类中存在显著差异。第1类在生活方式驱动的癌症预防方面表现出色，而第4类中的系统性障碍需要紧急的医疗投资和政策改革。中间聚类表现出受社会稳定、环境卫生和医疗基础设施影响的差异。分析强调了关键预测因素的差异，如人乳头瘤病毒疫苗接种覆盖率、医疗支出、公共卫生政策以及获得预防服务的机会。
本研究强调了制定针对特定聚类的策略以减少妇科癌症结果差异的重要性。干预措施应优先考虑公平获得预防性护理、改变生活方式和进行医疗投资，特别是在资源有限的地区。研究结果与可持续发展目标中关于健康和福祉（SDG 3）以及性别平等（SDG 5）的目标一致，为加快实现世界卫生组织的90-70-90目标以及消除宫颈癌这一公共卫生威胁提供了可操作的见解。
