Trends in the incidence and mutational landscape of advanced uterine cancer

Objective: The aim of this study was to examine disparities in 20-year incidence trends and mutations in advanced-stage uterine cancer in the United States, given poor survival rates. Methods: Data were obtained from the United States Cancer Statistics for patients from 2001 to 2019 with International Federation of Gynecology and Obstetrics 2009 stage IVA and IVB uterine cancer. SEER∗Stat 8.3.9.2 and Joinpoint Regression Program 4.9.0.0 were used to calculate cancer incidence per 100,000 women, annual percentages, and average annual percent change (AAPC). The mutational landscape of advanced uterine cancer was explored using data from the Genomic Data Commons. Results: In United States Cancer Statistics, 75,450 patients with advanced uterine cancer were identified with an annual percentage increase of 2.63% between 2001 and 2019 and significantly higher rates in Black, Hispanic, and Asian patients compared with White patients (AAPC Black: 3.56%, AAPC Hispanic: 3.12%, and AAPC Asian 3.06% vs AAPC White: 2.07%, each p < .001). AAPC in patients with serous carcinomas increased by 6.32% in Black vs 3.91% in White patients (p < .001). Furthermore, AAPC was 3.0% for Black patients vs 0.7% for White patients with leiomyosarcoma (p < .001). In the Genomic Data Commons, TP53 mutations were more common, and PTEN was less common in Black vs White patients, older vs younger patients, advanced vs early stage, or high- vs low-risk histologic subtypes (p < .05). Mutations in BRCA1, BRCA2, POLE, and PMS2 were less common in high- vs low-risk histologic subtypes (p < .05). Conclusion: Advanced-stage uterine cancer rates are rising in the United States, particularly affecting Black and Hispanic women. Molecular differences exist by age, race, stage, and histology.