Indicators of cure for women living after uterine and ovarian cancers: a population-based study

Abstract

This study aims to estimate long-term survival, cancer prevalence, and several cure indicators for Italian women with gynecological cancers. Thirty-one cancer registries, representing 47% of the Italian female population, were included. Mixture cure models were used to estimate net survival, cure fraction, time to cure (when 5-year conditional net survival becomes > 95%), cure prevalence (women who will not die of cancer), and already cured (living longer than time to cure). In 2018, 0.4% (121 704) of Italian women were alive after diagnosis of corpus uteri cancer, 0.2% (52 551) after cervical cancer, and 0.2% (52 153) after ovarian cancer. More than 90% of patients with uterine cancers and 83% with ovarian cancer will not die from their neoplasm (cure prevalence). Women with gynecological cancers have a residual excess risk of death <5% at 5 years after diagnosis. The cure fraction was 69% for corpus uteri, 32% for ovarian, and 58% for cervical cancer patients. Time to cure was ≤10 years for women with gynecological cancers aged <55 years; 74% of patients with cervical cancer, 63% with corpus uteri cancer, and 55% with ovarian cancer were already cured. These results can contribute to improving follow-up programs for women with gynecological cancers and supporting efforts against discrimination of already cured ones. This article is part of a Special Collection on Gynecological Cancers.

Keywords: cancer prevalence; cervical cancer; corpus uteri cancer; cure fraction; long-term survival; mixture cure models; ovarian cancer; time to cure.

Figure 1

Cure fraction (%) for gynecological cancer patients diagnosed in Italy in 2000 and 2010 by site and age at diagnosis. Cure fraction was estimated as net survival until age 100 years. Estimates for all age groups were calculated as the average of age-specific cure fractions, weighted by the proportion of incident cases in the corresponding age group.

Figure 2

Cure prevalence (CurePrev) for gynecological cancer patients by site and years since diagnosis. Italy, 2018. Each bar of the figure represents the proportions of prevalent cases per 100 000 women by time since diagnosis in 5-year periods, at all ages as of January 1, 2018. For each time interval, the green part of the bars indicates the women who have the same life expectancy as their peers in the general population. The cure prevalence is the proportion of these women, expected not to die as a result of their cancer, out of the total prevalent cases (ie, 91.3% for corpus uteri cancer, all ages). Focusing on patients alive more than 5, 10, or 15 years after diagnosis (included in the red, orange, and blue boxes, respectively), the cure prevalence is the probability of being cured, conditioned to survive at least 5, 10, or 15 years after diagnosis. The complement of these probabilities (ie, 1 − CurePrev) can be read as a residual excess risk of death.