Trends in hysterectomy-corrected uterine cancer mortality rates during 2002-2015: mortality of non-endometrioid cancer on the rise?
Menée au Danemark à partir des données de registres sur la période 2002-2015, cette étude analyse, chez les femmes âgées de plus de 35 ans et atteintes d'un cancer de l'endomètre, l'évolution de la mortalité prenant en compte les hystérectomies
Corpus uteri cancer is the most common gynecological malignancy in most developed countries. The disease is typically diagnosed at an early stage, is of endometrioid histologic subtype, and has a fairly good prognosis. Here, we describe hysterectomy-corrected mortality rates of corpus uteri cancer, overall and stratified by age, stage, and histologic subtype. Using data from nationwide Danish registries, we calculated uncorrected and hysterectomy-corrected age-standardized mortality rates of corpus uteri cancer among women ≥ 35 years during 2002-2015. Individual-level hysterectomy status was obtained from national registries; hysterectomy-corrected mortality rates were calculated by subtracting post-hysterectomy person-years from the denominator, unless hysterectomy was performed due to corpus uteri cancer. Correction for hysterectomy resulted in a 25.5% higher mortality rate (12.3/100,000 person-years vs. 9.8/100,000 person-years). Mortality rates were highest in women aged 70+, irrespective of year of death, histologic subtype, and stage. A significant decline was observed in overall hysterectomy-corrected mortality rates during 2002-2015, particularly among women aged 70+. Mortality rates of endometrioid cancer declined significantly over time (annual percent change (APC): -2.32, 95% CI -3.9, -0.7, p=0.01), whereas rates of non-endometrioid cancer increased (APC: 5.90, 95% CI: 3.0, 8.9, p<0.001). With respect to stage, mortality rates increased significantly over time for FIGOI-IIa (APC: 6.18 (95% CI: 1.9, 10.7) p=0.01) but remained unchanged for FIGO IIb-IV. In conclusion, increasing mortality rates of non-endometrioid cancer paralleled the previously observed rise in incidence rates of this histologic subtype. Given the poor prognosis of non-endometrioid cancer, more studies are needed to clarify the underlying reason for these findings. This article is protected by copyright. All rights reserved.