Yamazawa Koji, Hirai Makiko, Fujito Atsuya, Nishi Hirokata, Terauchi Fumitoshi, Ishikura Hiroshi, Shozu Makio, Isaka Keiichi
Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku, Tokyo 160-0023, Japan.
Hum Reprod. 2007 Jul;22(7):1953-8. doi: 10.1093/humrep/dem088. Epub 2007 Apr 21.
There are therapeutic dilemmas regarding conservative management of endometrial cancer in young women.
We planned a prospective study to conservatively treat women aged under 40 years with clinical stage 1A, grade 1 endometrioid adenocarcinoma from 1999 to 2005. There were nine women (aged 28-40) who fulfilled the criteria, and medroxyprogesterone acetate (400 mg/day) was continued for 6 months. Curettage materials were pathologically evaluated according to our criteria including partial response (PR) (a small amount of cancer tissue with remarkable hormonal effects or atypical hyperplasia). To predict complete response (CR) to progestin, immunohistochemical staining for insulin-like growth factor type 1 receptor, phosphatase and tensin homolog deleted on chromosome ten, progesterone receptor (PgR), estrogen receptor and Ki67 were assessed.
Seven (78%) and two cases presented complete and PRs, respectively. Two patients developed recurrent disease 10 and 22 months after the last dilatation and curettage, and both had synchronous ovarian cancer. However, all nine patients were alive and disease-free for a mean of 39 months. Of eight married patients, four (50%) conceived and three delivered full-term singletons. CR was related to positive expression of PgR (P=0.008).
Patients with an initial PR can obtain CR after further treatment, and the PgR may be useful in predicting CR to fertility-preserving treatment in young women with endometrial cancer.
年轻女性子宫内膜癌的保守治疗存在治疗困境。
我们计划进行一项前瞻性研究，对1999年至2005年间年龄在40岁以下、临床分期为1A期、1级子宫内膜样腺癌的女性进行保守治疗。有9名女性（年龄28 - 40岁）符合标准，醋酸甲羟孕酮（400毫克/天）持续使用6个月。根据我们的标准对刮宫材料进行病理评估，包括部分缓解（PR）（少量具有显著激素效应或非典型增生的癌组织）。为预测对孕激素的完全缓解（CR），评估胰岛素样生长因子1型受体、第10号染色体上缺失的磷酸酶和张力蛋白同源物、孕激素受体（PgR）、雌激素受体和Ki67的免疫组化染色。
分别有7例（78%）和2例呈现完全缓解和部分缓解。2例患者在最后一次刮宫后10个月和22个月出现复发性疾病，且均患有同步性卵巢癌。然而，所有9例患者均存活且无疾病，平均时间为39个月。8名已婚患者中，4例（50%）受孕，3例足月分娩单胎。完全缓解与孕激素受体的阳性表达相关（P = 0.008）。
初始部分缓解的患者经进一步治疗可获得完全缓解，孕激素受体可能有助于预测年轻子宫内膜癌女性保留生育功能治疗的完全缓解情况。
