Racial and ethnic differences in early death after cancer diagnosis have not been well studied in gynecologic malignancy. This study aimed to assess population-level trends and characteristics of early death among patients with gynecologic malignancy based on race and ethnicity in the United States. The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program was queried to examine 461,300 patients with gynecologic malignancies from 2000 to 2020, including uterine (n=242,709), tubo-ovarian (n=119,989), cervical (n=68,768), vulvar (n=22,991), and vaginal (n=6843) cancers. Early death, defined as a mortality event within 2 months of the index cancer diagnosis, was evaluated per race and ethnicity. At the cohort level, early death occurred in 21,569 patients (4.7%), including 10.5%, 5.5%, 2.9%, 2.5%, and 2.4% for tubo-ovarian, vaginal, cervical, uterine, and vulvar cancers, respectively (<.001). In a race- and ethnicity-specific analysis, non-Hispanic Black patients with tubo-ovarian cancer had the highest early death rate (14.5%). Early death racial and ethnic differences were the largest in tubo-ovarian cancer (6.4% for Asian vs 14.5% for non-Hispanic Black), followed by uterine (1.6% for Asian vs 4.9% for non-Hispanic Black) and cervical (1.8% for Hispanic vs 3.8% to non-Hispanic Black) cancers (all, <.001). In tubo-ovarian cancer, the early death rate decreased over time by 33% in non-Hispanic Black patients from 17.4% to 11.8% (adjusted odds ratio, 0.67; 95% confidence interval, 0.53–0.85) and 23% in non-Hispanic White patients from 12.3% to 9.5% (adjusted odds ratio, 0.77; 95% confidence interval, 0.71–0.85), respectively. The early death between-group difference diminished only modestly (12.3% vs 17.4% for 2000–2002 [adjusted odds ratio for non-Hispanic White vs non-Hispanic Black, 0.54; 95% confidence interval, 0.45–0.65] and 9.5% vs 11.8% for 2018–2020 [adjusted odds ratio, 0.65; 95% confidence interval, 0.54–0.78]). Overall, approximately 5% of patients with gynecologic malignancy died within the first 2 months from cancer diagnosis, and the early death rate exceeded 10% in non-Hispanic Black individuals with tubo-ovarian cancer. Although improving early death rates is encouraging, the difference among racial and ethnic groups remains significant, calling for further evaluation.

中文翻译：

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妇科恶性肿瘤早期死亡的种族和民族差异

妇科恶性肿瘤中癌症诊断后早期死亡的种族和民族差异尚未得到充分研究。本研究旨在评估美国不同种族和民族的妇科恶性肿瘤患者的人口水平趋势和早期死亡特征。美国国家癌症研究所的监测、流行病学和最终结果计划对 2000 年至 2020 年间 461,300 名妇科恶性肿瘤患者进行了调查，包括子宫癌 (n=242,709)、输卵管卵巢癌 (n=119,989)、宫颈癌 (n=68,768)、外阴癌 (n=22,991) 和阴道癌 (n=6843)。早期死亡定义为癌症诊断后 2 个月内的死亡事件，按种族和民族进行评估。在队列水平上，21,569 名患者 (4.7%) 发生早期死亡，其中输卵管卵巢癌、阴道癌、宫颈癌、子宫癌和外阴癌的早期死亡率分别为 10.5%、5.5%、2.9%、2.5% 和 2.4%（< .001）。在针对种族和民族的分析中，患有输卵管卵巢癌的非西班牙裔黑人患者的早期死亡率最高（14.5%）。早期死亡的种族和民族差异在输卵管卵巢癌中最大（亚洲人为 6.4%，非西班牙裔黑人为 14.5%），其次是子宫癌（亚洲人为 1.6%，非西班牙裔黑人为 4.9%）和宫颈癌（1.8%）。西班牙裔癌症百分比与非西班牙裔黑人癌症百分比分别为 3.8%（全部 <.001）。在输卵管卵巢癌中，非西班牙裔黑人患者的早期死亡率随时间推移下降了 33%，从 17.4% 降至 11.8%（调整后的比值比为 0.67；95% 置信区间为 0.53-0.85），非西班牙裔黑人患者的早期死亡率为 23%。西班牙裔白人患者的比例分别从 12.3% 降至 9.5%（调整后优势比，0.77；95% 置信区间，0.71-0.85）。组间早期死亡差异仅略有减小（2000-2002 年为 12.3% 与 17.4% [调整后的非西班牙裔白人与非西班牙裔黑人比值比，0.54；95% 置信区间，0.45-0.65] 和 9.5% 与2018-2020 年为 11.8% [调整后优势比，0.65；95% 置信区间，0.54-0.78]）。总体而言，大约 5% 的妇科恶性肿瘤患者在癌症诊断后的头 2 个月内死亡，非西班牙裔黑人输卵管卵巢癌的早期死亡率超过 10%。尽管早期死亡率的改善令人鼓舞，但种族和民族之间的差异仍然很大，需要进一步评估。