Corpus Uteri Malignancies in The Netherlands since the 1980’s: Registry-based studies of variation in incidence and outcome

Abstract

This thesis provides detailed information on the epidemic of corpus uteri malignancies in the Netherlands. We present age, stage, and histology-specific trends in incidence, relative survival rates, and mortality of uterine malignancies between 1989 and 2009, with a view to assessing the progress against uterine malignancies during the past two decades. The majority of uterine malignancies, approximately 80%, appear to be endometrioid endometrial carcinomas (EECs). The remaining 15% are non-endometrioid endometrial carcinomas (NEECs), a percentage that might possibly decrease with the improvement of pathologic classification. A minority (4%) comprised the mesenchymal corpus uteri malignancies, also referred to as sarcomas. Contrary to NEEC, EEC has a good prognosis. In these types of cancer relative survival statistics are of limited clinical relevance, because relative survival and observed survival differ. Observed survival reflects the effects of both non-cancer-related and cancer-related causes of death. Therefore, we explored the influence of patient characteristics like co-morbidity, such as diabetes mellitus, age of treatment, and survival. As progress is made, the number of EEC survivors will increase. The actual benefit of progress against uterine malignancies needs to be analysed in relation to the long-term sequelae of cancer management and the health-related quality of life (HRQoL) of cancer survivors. The number of long-term EEC survivors are expected to increase substantially, i.e. 3-5% per year. For this reason we presented a HRQoL analysis of EEC cancer survivors. Gynaecologists are having to deal with an increasing number of women with a high body mass index (BMI) who develop EEC. This called for a HRQoL analysis according to BMI, because recovery and rehabilitation of these women may be hampered.