Endometrial cancer has continued to see a rising incidence in the US over the years. The main aim of this study was to assess current trends in patients’ characteristics and outcomes of treatment for endometrial carcinoma over 16 years. A dataset from the National Cancer Database (NCDB) for patients diagnosed with endometrial carcinoma from 2005 to 2020 was used in this retrospective, case series study. The main outcomes and measures of interest included tumor characteristics, hospitalization, treatments, mortality, and overall survival. Then, 569,817 patients who were diagnosed with endometrial carcinoma were included in this study. The mean (SD) age at diagnosis was 62.7 (11.6) years, but 66,184 patients (11.6%) were younger than 50 years, indicating that more patients are getting diagnosed at younger ages. Of the patients studied, 37,079 (6.3%) were Hispanic, 52,801 (9.3%) were non-Hispanic Black, 432,058 (75.8%) were non-Hispanic White, and 48,879 (8.6%) were other non-Hispanic. Patients in the 4th period from 2017 to 2020 were diagnosed more with stage IV (7.1% vs. 5.2% vs. 5.4% vs. 5.9%;p< 0.001) disease compared with those in the other three periods. More patients with severe comorbidities (Charlson Comorbidity Index score of three) were seen in period 4 compared to the first three periods (3.9% vs. ≤1.9%). Systemic chemotherapy use (14.1% vs. 17.7% vs. 20.4% vs. 21.1%;p< 0.001) and immunotherapy (0.01% vs. 0.01% vs. 0.2% vs. 1.1%;p< 0.001) significantly increased from period 1 to 4. The use of laparotomy decreased significantly from 42.1% in period 2 to 16.7% in period 4, while robotic surgery usage significantly increased from 41.5% in period 2 to 64.3% in period 4. The 30-day and 90-day mortality decreased from 0.6% in period 1 to 0.2% in period 4 and 1.4% in period 1 to 0.6% in period 4, respectively. Over the period studied, we found increased use of immunotherapy, chemotherapy, and minimally invasive surgery for the management of endometrial cancer. Overall, the time interval from cancer diagnosis to final surgery increased by about 6 days. The improvements observed in the outcomes examined can probably be associated with the treatment trends observed.
多年来，子宫内膜癌在美国的发病率持续上升。本研究的主要目的是评估16年间子宫内膜癌患者特征及治疗结局的当前趋势。这项回顾性病例系列研究使用了美国国家癌症数据库（NCDB）中2005年至2020年诊断为子宫内膜癌患者的数据集。主要关注的结果和指标包括肿瘤特征、住院情况、治疗方案、死亡率及总生存期。本研究共纳入569,817名诊断为子宫内膜癌的患者。诊断时的平均（标准差）年龄为62.7（11.6）岁，但66,184名患者（11.6%）年龄小于50岁，表明更多患者在较年轻时被确诊。在研究患者中，37,079人（6.3%）为西班牙裔，52,801人（9.3%）为非西班牙裔黑人，432,058人（75.8%）为非西班牙裔白人，48,879人（8.6%）为其他非西班牙裔人群。与其他三个时期相比，2017年至2020年第四时期的患者被诊断为IV期疾病的比例更高（7.1% vs. 5.2% vs. 5.4% vs. 5.9%；p<0.001）。与前三个时期相比，第四时期患有严重合并症（查尔森合并症指数评分为3分）的患者更多（3.9% vs. ≤1.9%）。从第一时期到第四时期，全身化疗使用率（14.1% vs. 17.7% vs. 20.4% vs. 21.1%；p<0.001）和免疫治疗使用率（0.01% vs. 0.01% vs. 0.2% vs. 1.1%；p<0.001）显著增加。开腹手术的使用率从第二时期的42.1%显著下降至第四时期的16.7%，而机器人手术的使用率从第二时期的41.5%显著上升至第四时期的64.3%。30天死亡率从第一时期的0.6%下降至第四时期的0.2%，90天死亡率从第一时期的1.4%下降至第四时期的0.6%。在研究期间，我们发现子宫内膜癌治疗中免疫治疗、化疗和微创手术的使用有所增加。总体而言，从癌症诊断到最终手术的时间间隔增加了约6天。观察到的结局改善可能与观察到的治疗趋势相关。
Temporal Trends in Treatment and Outcomes of Endometrial Carcinoma in the United States, 2005–2020
肿瘤(癌症)患者之家