Abstract / Summary
Abstract Long-term survivors of endometrial cancer face competing risks from cancer and other conditions, but how these risks evolve remains uncertain. We conducted a population-based retrospective cohort study of 255,104 women who underwent hysterectomy-based definitive surgery for endometrial cancer in the Surveillance, Epidemiology, and End Results Program (2000–2021). Cause-specific cumulative incidence was estimated using Aalen–Johansen methods. Crossover was the earliest month when composite non-endometrial mortality (cardiovascular, other malignant cancer, or other non-cancer death) exceeded endometrial cancer-specific mortality and remained higher for 12 months. During a median follow-up of 8.2 years, 62,347 deaths occurred. Endometrial cancer mortality was 6.2%, 7.1%, and 7.4% at 5, 10, and 15 years, compared with 5.3%, 16.6%, and 28.3% for composite non-endometrial mortality. Crossover occurred at 5.6 years (95% confidence interval, 5.4–5.8) overall but was not reached within 15 years for stage III/IV disease or chemotherapy recipients. Among 10-year survivors, subsequent 5-year mortality was 0.4% from endometrial cancer and 15.3% from non-endometrial causes; cardiovascular mortality remained elevated relative to U.S. female rates (standardized mortality ratio, 1.21; 95% confidence interval, 1.16–1.26). These findings support integrated cardiovascular and metabolic risk management from diagnosis alongside individualized, guideline-concordant oncologic surveillance.