Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France; Unit INSERM U 1030, Gustave Roussy, Villejuif, France; Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France.
Department of Medical Oncology, Gustave Roussy, Villejuif, France; Translational Research Lab U981, Gustave Roussy, Villejuif, France.
Lancet. 2016 Mar 12;387(10023):1094-1108. doi: 10.1016/S0140-6736(15)00130-0. Epub 2015 Sep 6.
Endometrial cancer is the most common gynaecological tumour in developed countries, and its incidence is increasing. The most frequently occurring histological subtype is endometrioid adenocarcinoma. Patients are often diagnosed when the disease is still confined to the uterus. Standard treatment consists of primary hysterectomy and bilateral salpingo-oophorectomy, often using minimally invasive approaches (laparoscopic or robotic). Lymph node surgical strategy is contingent on histological factors (subtype, tumour grade, involvement of lymphovascular space), disease stage (including myometrial invasion), patients' characteristics (age and comorbidities), and national and international guidelines. Adjuvant treatment is tailored according to histology and stage. Various classifications are used to assess the risks of recurrence and to determine optimum postoperative management. 5 year overall survival ranges from 74% to 91% in patients without metastatic disease. Trials are ongoing in patients at high risk of recurrence (including chemotherapy, chemoradiation therapy, and molecular targeted therapies) to assess the modalities that best balance optimisation of survival with the lowest adverse effects on quality of life.
子宫内膜癌是发达国家最常见的妇科肿瘤，其发病率正在上升。最常见的组织学亚型是子宫内膜样腺癌。患者通常在疾病仍局限于子宫时被诊断出来。标准治疗包括子宫切除术和双侧输卵管卵巢切除术，通常采用微创方法（腹腔镜或机器人）。淋巴结手术策略取决于组织学因素（亚型、肿瘤分级、淋巴管血管空间受累）、疾病分期（包括肌层浸润）、患者特征（年龄和合并症）以及国家和国际指南。辅助治疗根据组织学和分期进行调整。各种分类用于评估复发风险，并确定最佳的术后管理。无转移疾病患者的 5 年总生存率为 74%至 91%。对于复发风险高的患者（包括化疗、放化疗和分子靶向治疗）正在进行试验，以评估最佳的生存优化与对生活质量的最低不良影响的平衡方式。
