Sorosky Joel I
Department of Obstetrics and Gynecology, Hartford Hospital, the University of Connecticut, Hartford, Connecticut 06102, USA.
Obstet Gynecol. 2008 Feb;111(2 Pt 1):436-47. doi: 10.1097/AOG.0b013e318162f690.
This review summarizes the epidemiology, prevention, diagnosis and treatment, and prognosis of endometrial carcinoma. Although the incidence of disease has remained stable, the death rate has increased over 100% over the last two decades. Precursor lesions of complex hyperplasia with atypia are associated with an endometrial carcinoma in over 40% of cases. The percentage of obese women with endometrial cancer is increasing. The incidence of endometrial cancer in white women is twice the incidence in African-American women, but stage for stage, African-American women have a less favorable prognosis. Preoperative imaging cannot accurately assess lymph node involvement. Gross examination of depth of myometrial invasion does not have the sensitivity, specificity, and positive or negative predictive value to select women who can have lymphadenectomy safely omitted from the surgical procedure. In the absence of ideal noninvasive preoperative testing, surgical staging remains the most accurate method of determining the extent of disease. There has been an increase in surgical staging and a decrease in postoperative adjuvant pelvic radiation therapy over the past two decades. Women with a family history of hereditary nonpolyposis colorectal colon cancer are at increased risk for endometrial cancer. Conservative treatment to allow for childbearing is possible in select situations. Women with endometrial cancer should be managed by physicians experienced in the treatment of this disease.
本综述总结了子宫内膜癌的流行病学、预防、诊断与治疗以及预后情况。尽管该疾病的发病率一直保持稳定，但在过去二十年中死亡率增长超过了100%。超过40%的非典型复杂增生前驱病变与子宫内膜癌相关。患子宫内膜癌的肥胖女性比例正在上升。白人女性子宫内膜癌的发病率是非裔美国女性的两倍，但在相同分期情况下，非裔美国女性的预后较差。术前影像学检查无法准确评估淋巴结受累情况。对肌层浸润深度进行大体检查，在选择可安全省略淋巴结清扫手术的女性时，其敏感性、特异性以及阳性或阴性预测价值均不足。在缺乏理想的非侵入性术前检测方法的情况下，手术分期仍然是确定疾病范围最准确的方法。在过去二十年中，手术分期有所增加，术后辅助盆腔放射治疗有所减少。有遗传性非息肉病性结直肠癌家族史的女性患子宫内膜癌的风险增加。在某些特定情况下，可以采取保守治疗以实现生育。患有子宫内膜癌的女性应由有该疾病治疗经验的医生进行管理。
