Lu Karen H
Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Semin Oncol. 2009 Apr;36(2):137-44. doi: 10.1053/j.seminoncol.2008.12.005.
Endometrial cancer is the most common gynecologic malignancy in the United States. The majority of women are diagnosed with early-stage disease. Surgical therapy of early-stage endometrial cancer includes full staging, including pelvic and para-aortic lymphadenectomy. While most women with early-stage endometrial cancer can anticipate cure with surgery alone, a significant minority of women with deeply invasive or high-grade tumors will experience local, regional, or distant recurrences of their disease. Therefore, adjuvant therapies have been proposed for these women. While radiotherapy is effective at reducing the risk of local and regional tumor recurrence, studies have demonstrated no improvement on survival. The role of systemic adjuvant chemotherapies in this high-risk, early-stage patient population is currently the focus of several randomized trials. In addition, for women with early-stage tumors with atypical histology, such as papillary serous and clear cell malignancies, the role of adjuvant therapy remains uncertain. Optimizing management of women with early-stage disease requires a careful assessment of the risk of recurrent disease, the potential benefit of various adjuvant strategies, and the risk associated with adjuvant therapy. New molecular markers may be helpful in the future to refine our ability to identify high-risk, early-stage patients.
子宫内膜癌是美国最常见的妇科恶性肿瘤。大多数女性被诊断为早期疾病。早期子宫内膜癌的手术治疗包括全面分期，其中包括盆腔和腹主动脉旁淋巴结清扫术。虽然大多数早期子宫内膜癌女性仅通过手术就能预期治愈，但少数具有深度浸润性或高级别肿瘤的女性会出现疾病的局部、区域或远处复发。因此，已针对这些女性提出辅助治疗。虽然放疗在降低局部和区域肿瘤复发风险方面有效，但研究表明对生存率并无改善。全身辅助化疗在这一高危早期患者群体中的作用目前是多项随机试验的重点。此外，对于具有非典型组织学的早期肿瘤女性，如乳头状浆液性和透明细胞恶性肿瘤，辅助治疗的作用仍不确定。优化早期疾病女性的管理需要仔细评估疾病复发风险、各种辅助策略的潜在益处以及辅助治疗相关风险。新的分子标志物未来可能有助于提高我们识别高危早期患者的能力。
