Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
Int J Gynecol Cancer. 2010 Aug;20(6):985-92. doi: 10.1111/IGC.0b013e3181e2abcc.
The aim of this review was to analyze the role of follow-up in patients treated for endometrial cancer and to provide some compelling issues that may contribute to improve daily practice while waiting for evidence-based guidelines.
METHODS/MATERIALS: A literature search has been conducted in MEDLINE database using key words "endometrial neoplasms" and "follow up".
Endometrial cancer represents the most common gynecologic malignancy after breast cancer. The overall recurrence rate is 13% and correlates with prognostic factors of the primary tumor. The anatomic sites of endometrial cancer relapse are mostly equivalently distributed between local (pelvic) and distant (abdominal and chest). Most endometrial cancer recurrences are symptomatic, even if vaginal vault relapses represent a particular setting of a more frequently asymptomatic disease. Most of endometrial cancer recurrences occur within 3 years since diagnosis of primary tumor. Long-term surveillance programs are mainly addressed to the early detection of recurrence, the rationale of follow-up being that an earlier diagnosis of relapse correlates with lower morbidity and mortality rates. Adjunctive objectives of routine follow-up are identification of treatment complications and detection of possible second tumors associated with endometrial cancer.
No rationale (examination sensitivity/sensibility, cost-effectiveness, or patient's survival benefit) is available today for any particular follow-up protocol; follow-up procedures should probably be tailored according to different prognostic factors; only physical examination, including pelvic-rectal examination, showed some utility in detecting recurrence. In this uncertain setting, follow-up interval should be defined with the consideration of the patient's will.
本综述旨在分析子宫内膜癌患者随访的作用，并提出一些可能有助于改善日常实践的重要问题，同时等待基于证据的指南。
方法/材料：在 MEDLINE 数据库中使用关键词“子宫内膜肿瘤”和“随访”进行了文献检索。
子宫内膜癌是继乳腺癌之后最常见的妇科恶性肿瘤。总的复发率为 13%，与原发性肿瘤的预后因素相关。子宫内膜癌复发的解剖部位在局部（盆腔）和远处（腹部和胸部）之间分布大致相等。大多数子宫内膜癌复发是有症状的，即使阴道穹窿复发是一种更常见的无症状疾病。大多数子宫内膜癌复发发生在诊断原发性肿瘤后 3 年内。长期监测计划主要针对复发的早期检测，随访的基本原理是早期诊断复发与降低发病率和死亡率相关。常规随访的辅助目标是识别治疗并发症和检测与子宫内膜癌相关的可能第二肿瘤。
目前，任何特定的随访方案都没有合理的依据（检查敏感性/敏感性、成本效益或患者的生存获益）；随访程序可能需要根据不同的预后因素进行定制；只有体格检查，包括盆腔直肠检查，在检测复发方面显示出一些作用。在这种不确定的情况下，应根据患者的意愿来确定随访间隔。
