title: Validated competing event model for the stage I-II endometrial cancer population.
abstract: Early-stage endometrial cancer patients are at higher risk of noncancer mortality than of cancer mortality. Competing event models incorporating comorbidity could help identify women most likely to benefit from treatment intensification.
  
  
  METHODS
  67,397 women with stage I-II endometrioid adenocarcinoma after total hysterectomy diagnosed from 1988 to 2009 were identified in Surveillance, Epidemiology, and End Results (SEER) and linked SEER-Medicare databases. Using demographic and clinical information, including comorbidity, we sought to develop and validate a risk score to predict the incidence of competing mortality.
  
  
  RESULTS
  In the validation cohort, increasing competing mortality risk score was associated with increased risk of noncancer mortality (subdistribution hazard ratio [SDHR], 1.92; 95% confidence interval [CI], 1.60-2.30) and decreased risk of endometrial cancer mortality (SDHR, 0.61; 95% CI, 0.55-0.78). Controlling for other variables, Charlson Comorbidity Index (CCI) = 1 (SDHR, 1.62; 95% CI, 1.45-1.82) and CCI >1 (SDHR, 3.31; 95% CI, 2.74-4.01) were associated with increased risk of noncancer mortality. The 10-year cumulative incidences of competing mortality within low-, medium-, and high-risk strata were 27.3% (95% CI, 25.2%-29.4%), 34.6% (95% CI, 32.5%-36.7%), and 50.3% (95% CI, 48.2%-52.6%), respectively. With increasing competing mortality risk score, we observed a significant decline in omega (ω), indicating a diminishing likelihood of benefit from treatment intensification.
  
  
  CONCLUSIONS
  Comorbidity and other factors influence the risk of competing mortality among patients with early-stage endometrial cancer. Competing event models could improve our ability to identify patients likely to benefit from treatment intensification.
authors: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors: Ruben
authors: R
authors: Carmona
authors: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors: Sachin
authors: S
authors: Gulaya
authors: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors: James D
authors: JD
authors: Murphy
authors: Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts.
authors: Brent S
authors: BS
authors: Rose
authors: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors: John
authors: J
authors: Wu
authors: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors: Sonal
authors: S
authors: Noticewala
authors: Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California.
authors: Michael T
authors: MT
authors: McHale
authors: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
authors: Catheryn M
authors: CM
authors: Yashar
authors: Department of Family and Preventive Medicine, Biostatistics and Bioinformatics, University of California San Diego Medical Center, San Diego, California.
authors: Florin
authors: F
authors: Vaida
authors: Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California. Electronic address: lmell@ucsd.edu.
authors: Loren K
authors: LK
authors: Mell
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D009367:Neoplasm Staging; D012044:Regression Analysis; D012306:Risk; D018426:SEER Program / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States