Engelsen Ingeborg B, Akslen Lars A, Salvesen Helga B
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
APMIS. 2009 Oct;117(10):693-707. doi: 10.1111/j.1600-0463.2009.02467.x.
With a lifetime risk among women of 2-3%, endometrial cancer is the most common pelvic gynecologic malignancy in industrialized countries. Approximately 75% of cases are diagnosed at an early stage with a tumor confined to the uterine corpus. Although most patients are cured by surgery alone, about 15-20% with no signs of locally advanced or metastatic disease at primary treatment recurs, with limited responsiveness to systemic therapy. The most common basis for determining the risk of recurrent disease has been classification of endometrial cancers into two subtypes. Type I, associated with a good prognosis, accounts for the majority of cases and is associated with a low-stage, low-grade and endometrioid histology. In contrast, type II, associated with a poor prognosis, is characterized by a high-stage, high-grade and non-endometrioid histology. However, the prognostic value of this distinction is limited, as up to 20% of type I endometrial cancers recur, while half of type II cancers do not. We review the current literature on epidemiology, etiology, pathology, molecular alterations, staging, treatment and prognostic factors in endometrial cancer. Ongoing molecular-based clinical trials and newly reported molecular alterations with a potential for development of new targeted therapy are discussed.
子宫内膜癌是工业化国家最常见的盆腔妇科恶性肿瘤，女性终生患病风险为2%-3%。约75%的病例在早期被诊断出来，肿瘤局限于子宫体。虽然大多数患者仅通过手术就能治愈，但约15%-20%在初次治疗时无局部晚期或转移性疾病迹象的患者会复发，对全身治疗的反应有限。确定复发风险最常见的依据是将子宫内膜癌分为两种亚型。I型预后良好，占大多数病例，与低分期、低级别和子宫内膜样组织学相关。相比之下，II型预后不良，其特征为高分期、高级别和非子宫内膜样组织学。然而，这种区分的预后价值有限，因为高达20%的I型子宫内膜癌会复发，而II型癌症中有一半不会复发。我们综述了目前关于子宫内膜癌的流行病学、病因学、病理学、分子改变、分期、治疗和预后因素的文献。还讨论了正在进行的基于分子的临床试验以及新报道的具有开发新靶向治疗潜力的分子改变。
