Trends in Patients Characteristics, Treatment, and Outcomes of Endometrial Cancer in the United States from 2005 to 2020
Introduction
Endometrial cancer is one type of cancer that has continued to see rising incidence and prevalence in the U.S. over the years. The overarching aim of this study was to assess current trends in the characteristics, treatment, and outcomes of endometrial carcinoma over 16 years.
Methods
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. Statistical analysis on the data was carried out between June and July 2023. We examined trends in the treatment and outcomes of interest for endometrial carcinoma in the U.S. from 2005 to 2020. Four periods were studied: 2005-2008, 2009-2012, 2013-2016, and 2017-2020. The main outcomes and measures included patient and tumor characteristics, treatments, hospitalization, mortality, and overall survival.
Results
Included in this study were 569,817 patients who were diagnosed with endometrial carcinoma. The mean (SD) age of the patients was 62.7 (11.6) years, but 66 184 patients (11.6%) were younger than 50 years. 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 Other Non-Hispanic, 48,879 (8.6%). Patients in the 3rd period from 2013 to 2016 were diagnosed more with stage IV (4.5% vs. 2.9% vs. 4.1% vs. 1.2%; P < 0.001) disease compared with those in the other three periods. Systemic chemotherapy use (14.1% vs. 17.7% vs. 20.4% vs. 21.1%; P <.001) and immunotherapy (0.01% vs. 0.01% vs. 0.17% vs. 1.10%; P <.001) were statistically significantly increased across the four periods studied. Neoadjuvant systemic therapy use increased across the periods studied (0.48% in period 1 to 1.34% in period 4) as well as adjuvant systemic therapy use (10.2% in period 1 to 17.5% in period 4). The median (IQR) time from diagnosis to final surgery increased from 26 (10-41) days in period 1 to 32 (16-48) days in period 4. The use of open surgery decreased by about half (27.3% in period 2 to 13.7% in period 4), while the use of robotic surgery doubled (26.9% in period 2 to 52.7% in period 4). The surgical conversion rate from minimally invasive to open surgery was reduced (1.9% in period 2 to 1.8% in period 4) and the median (IQR) hospital stay decreased by 2 days, from 3 (2-4) days to 1 (0-1) days. Thirty-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.
Conclusion
We found increased use of immunotherapy, chemotherapy, and minimally invasive surgery for management of individuals with endometrial cancer over the years. Furthermore, time interval between diagnosis and final surgery increased by a median of six days. These results have important clinical relevance in the treatment of endometrial carcinoma. Moreover, the improvements observed in the outcomes examined can probably be linked to the treatment trends observed. Future studies are needed to continue to monitor the trends in treatment outcomes and survival.