Trends in the incidence and survival outcomes of endometrial cancer in Korea: a nationwide population-based cohort study

Abstract

Objective: To evaluate trends in the incidence and survival outcomes of endometrial cancer (EC) based on the year of diagnosis, stage, age, and histologic types.

Methods: Women with primary EC diagnosed between 1999 and 2018, and who were followed up with until 2019, were identified from the Korea Central Cancer Registry using the International Classification of Diseases, 10th revision. The age-standardized rates (ASRs) of incidence, annual percent changes (APCs), and survival were estimated according to age, stage, histology, and year of diagnosis.

Results: The ASR for EC increased from 2.38 per 100,000 in 1999 to 7.29 per 100,000 in 2018 across all histologic types (APCs of 9.82, 15.97, and 7.73 for endometrioid, serous, and clear cell, respectively, p<0.001). There were significant differences in the 5-year survival rates based on histology (90.9%, 55.0%, and 68.5% for endometrioid, serous, and clear cell, respectively, p<0.001), stage (93.4%, 77.0%, and 31.0% for localized, regional, and distant, respectively, p<0.001), and age (93.0% for <50 years and 80.6% for ≥50 years, p<0.001). The 5-year survival was significantly better in the group diagnosed between 2000 and 2018 (85.9%) than that in the 1999-2008 group (83.3%) (p<0.001). This trend was only observed for endometrioid cancer (p<0.001).

Conclusion: The incidence of EC increased across the all 3 subtypes. Survival of patients with endometrioid histology improved over the past two decades, but remained static for serous or clear cell histology. Healthcare strategies to prevent EC incidence in at-risk populations and apply effective treatments for high-risk histology are needed.

Keywords: Cancer Staging; Endometrial Cancer; Histology; Incidence; Survival.

Fig. 1. Overall survival of patients with endometrial stratified according to histology, 2006–2016. (A) All, (B) Histology.

Fig. 2. Overall survival of patients with endometrial stratified according to year of diagnosis (1999–2008 vs. 2009–2018). (A) All, (B) Endometrioid, (C) Serous, (D) Clear cell.

Fig. 3. Overall survival of patients with endometrial stratified according to stage (localized, regional, and distant). (A) All, (B) Endometrioid, (C) Serous, (D) Clear cell.

Fig. 4. Overall survival of patients with endometrial stratified according to age (<50 years and ≥50 years). (A) All, (B) Endometrioid, (C) Serous, (D) Clear cell.