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#525 Trends of early-death in gynecologic malignancy: a population-based analysis
  1. Maximilian Klar1,
  2. Andrew Vallejo2,
  3. Lynda D Roman2,3,
  4. Jason D Wright4 and
  5. Koji Matsuo2,3
  1. 1University of Freiburg, Freiburg, Germany
  2. 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
  3. 3Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
  4. 4Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York City, USA


Introduction/Background In cancer care, mortality event occurring soon after the diagnosis of malignancy (early-death) reflects an indicator for various patient, tumor, and treatment factors. The objective of this study was to assess temporal trends of early-death in gynecologic malignancy at population level in the United States.

Methodology This retrospective observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2000–2020. The study population was 461,321 patients with gynecologic malignancies (uterine [n=242,716], tubo-ovarian [n=119,995], cervical [n=68,771], vulvar [n=22,995], and vaginal [n=6,844] cancers) who had at least 2 months of follow-up after diagnosis. Outcome was early-death, defined as mortality event occurred within 2 months from cancer diagnosis. Linear segmented regression with log-transformation was used to assess temporal trends using one-year increments in each malignancy type.

Results Tubo-ovarian cancer had the highest rate of early-death (10.5%), followed by vaginal (5.5%), cervical (2.9%), uterine (2.5%), and vulvar (2.5%) cancers (P<0.001). For tubo-ovarian cancer, early-death rate decreased from 11.8% to 9.8% (annual percentage rate change [APC] -2.0, 95% confidence interval [CI] -2.4 to -1.6, P<0.001). For uterine cancer, early-death rate decreased from 2.7% to 2.2% between 2000–2018 (APC -1.0, 95%CI -1.4 to -0.5, P<0.001) but rapid increase occurred from 2.2% to 3.4% between 2018–2020 (APC 19.2, 95%CI 6.2–33.7, P=0.005). For cervical cancer, early-death rate continued to increase from 2.8% to 3.9% (APC 0.9, 95%CI 0.1–1.6, P=0.021). The early-death rates were unchanged in vulvar (P=0.587) and vaginal (P=0.518) cancers.

Conclusion This population-based analysis in the United States suggested that while decreasing ovarian cancer patients had disproportionately higher rate of early-death after diagnosis compared to other gynecologic malignancies. (i) Persistent increase in early-death rate among cervical cancer patients over decades and (ii) recent rapid increase in early-death rate among uterine cancer are both concerning, warranting attention and further investigation.

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