Population-level survival trends for uterine cancer

Abstract

Objectives: Both primary therapy and adjuvant therapy for uterine cancer have evolved. Although survival estimates from randomized trials have shown improved survival, it remains unclear whether treatment changes have translated into improved survival in the broader population. Population-level survival analyses are complicated by improved longevity as a whole in women. We examined relative survival, a measure that compares survival in women with cancer to the general population, to determine the excess mortality associated with uterine cancer over the last 25 years. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, women with uterine cancer diagnosed from 1983 to 2009 were identified. Survival was analyzed after adjustment for age, race, stage, year of diagnosis, and time since diagnosis. Relative survival was estimated by comparing observed survival after diagnosis of cancer to expected survival obtained from the general United States population matched on calendar year, age, and race. Results: A total of 121,948 women were identified. For stages I–III uterine cancer, we found a temporal reduction in excess mortality. Among women with stage I uterine cancer, the excess HR for women diagnosed in 2009 was 0.53 (95% CI, 0.44–0.64) compared to those diagnosed in 1983, 0.63 (95% CI, 0.55–0.72) compared to those diagnosed in 1990, and 0.80 (95% CI, 0.75–0.86) compared to those diagnosed in 2000. Similarly, for women with stage III tumors, the excess HR for women in 2009 was 0.50 (95% CI, 0.44–0.59) compared to 1983, 0.61 (95% CI, 0.54–0.68) compared to 1990, and 0.79 (95% CI, 0.75–0.83) compared to 2000. Similar trends were noted for women with stage II tumors. Conclusions: Relative survival has improved for stages I–III uterine cancer. Advances in surgical treatment and the delivery of adjuvant therapy may have resulted in improved population-level survival in the United States.