Impact of patient characteristics on primary treatment approach of endometrial cancer: a population-based study in the Netherlands

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Objective The incidence of endometrial cancer is rising worldwide, with increasing numbers of elderly with substantial comorbidity. We aimed to provide insight into the primary treatment strategies, trends, and outcomes for patients with endometrial cancer in the Netherlands across different time periods, and to evaluate the influence of patient characteristics on treatment approaches within these periods. Methods All patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I-III endometrial cancer between 1995 and 2022 were identified in the Netherlands Cancer Registry. Data on histology, FIGO stage, primary treatment, Charlson comorbidity index, body mass index and outcome were collected and analysed. Patients were evaluated in six cohorts of five years each, to observe possible trends over time in treatment choice and outcome depending on patient and tumour characteristics. Results A total of 43,443 patients were included. Most patients were diagnosed with endometrioid histology (89%, N=38,751) and early-stage disease (FIGO I-II, 87%, N=38,077). An increased endometrial cancer incidence and survival was observed over time, with a shift towards more non-endometrioid endometrial cancer. A primary surgical approach was performed in 95% (n=41,107) of patients and within the group receiving non-surgical management, curative treatment was only reported in 4% (n=88). Most patients unfit for surgery did not receive any treatment (n=1,053, 2%) or received hormonal therapy (n=840, 2%). Over time, we observed increased use of hormonal therapy as non-surgical treatment. Patients who did not undergo surgery were older, more often had a body mass index >30 kg/m 2 and had more often Charlson comorbidity index 2+. Conclusion Incidence and survival in endometrial cancer patients increased between 1999 and 2022. Patients unfit for surgery most often received no treatment or palliative hormonal therapy. Curative radiotherapy is not often used in patients unfit for surgery and should be considered for this group of patients.

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