Singh Naveena, Hirschowitz Lynn, Zaino Richard, Alvarado-Cabrero Isabel, Duggan Maire A, Ali-Fehmi Rouba, Euscher Elizabeth, Hecht Jonathan L, Horn Lars-Christian, Ioffe Olga, Matias-Guiu Xavier, McCluggage W Glenn, Mikami Yoshiki, Ordi Jaume, Parkash Vinita, Quddus M Ruhul, Quick Charles M, Staebler Annette, Zaloudek Charles, Nucci Marisa, Malpica Anais, Oliva Esther
Department of Cellular Pathology, Barts Health NHS Trust, London (N.S.) Department of Cellular Pathology, Birmingham Women's NHS Trust, Birmingham (L.H.) Department of Pathology, Belfast Health and Social Care Trust, Belfast (W.G.M.), UK Division of Anatomic Pathology, Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania (R.Z.) Department of Pathology, Mexico City Hospital of Oncology, Mexico City, Mexico (I.A.-C.) Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada (M.A.D.) Department of Pathology, Wayne State University, Detroit, Michigan (R.A.-F.) Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.E., A.M.) Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School (J.L.H.) Department of Pathology, Brigham and Women's Hospital, Harvard Medical School (M.N.) Department of Pathology, Massachusetts General Hospital, Harvard Medical School (E.O.), Boston, Massachusetts Division of Gynecologic, Breast & Perinatal Pathology, University Hospital Leipzig, Leipzig (L.-C.H.) Institute of Pathology, University Hospital of Tübingen, Tübingen (A.S.), Germany Department of Anatomical Pathology, University of Maryland, College Park, Maryland (O.I.) Pathological Oncology Group and Pathology Department, University Hospital of Arnau de Vilanova, Lleida (X.M.-G.) Department of Pathology, Hospital Clinic of Barcelona, ISGlobal, Barcelona Center for International Health Research, University of Barcelona, Barcelona (J.O.), Spain Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan (Y.M.) Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (V.P.) Department of Pathology, Women and Infants Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island (M.R.Q.) Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (C.M.Q.) Department of Pathology, University of California, San Francisco, San Francisco, California (C.Z.).
Int J Gynecol Pathol. 2019 Jan;38 Suppl 1(Iss 1 Suppl 1):S93-S113. doi: 10.1097/PGP.0000000000000524.
Although endometrial carcinoma (EC) is generally considered to have a good prognosis, over 20% of women with EC die of their disease, with a projected increase in both incidence and mortality over the next few decades. The aim of accurate prognostication is to ensure that patients receive optimal treatment and are neither overtreated nor undertreated, thereby improving patient outcomes overall. Patients with EC can be categorized into prognostic risk groups based on clinicopathologic findings. Other than tumor type and grade, groupings and recommended management algorithms may take into account age, body mass index, stage, and presence of lymphovascular space invasion. The molecular classification of EC that has emerged from the Cancer Genome Atlas (TCGA) study provides additional, potentially superior, prognostic information to traditional histologic typing and grading. This classifier does not, however, replace clinicopathologic risk assessment based on parameters other than histotype and grade. It is envisaged that molecular and clinicopathologic prognostic grouping systems will work better together than either alone. Thus, while tumor typing and grading may be superseded by a classification based on underlying genomic abnormalities, accurate assessment of other pathologic parameters will continue to be key to patient management. These include those factors related to staging, such as depth of myometrial invasion, cervical, vaginal, serosal surface, adnexal and parametrial invasion, and those independent of stage such as lymphovascular space invasion. Other prognostic parameters will also be discussed. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project.
虽然子宫内膜癌（EC）通常被认为预后良好，但超过20%的EC女性患者死于该疾病，预计在未来几十年发病率和死亡率都将上升。准确预后的目的是确保患者接受最佳治疗，既不过度治疗也不治疗不足，从而总体上改善患者预后。EC患者可根据临床病理结果分为预后风险组。除肿瘤类型和分级外，分组和推荐的管理算法可能会考虑年龄、体重指数、分期以及是否存在淋巴管间隙浸润。癌症基因组图谱（TCGA）研究中出现的EC分子分类为传统组织学分型和分级提供了额外的、可能更优越的预后信息。然而，该分类器并不能取代基于组织类型和分级以外参数的临床病理风险评估。预计分子和临床病理预后分组系统结合使用比单独使用效果更好。因此，虽然肿瘤分型和分级可能会被基于潜在基因组异常的分类所取代，但准确评估其他病理参数仍将是患者管理的关键。这些参数包括与分期相关的因素，如肌层浸润深度、宫颈、阴道、浆膜表面、附件和宫旁浸润，以及与分期无关的因素，如淋巴管间隙浸润。还将讨论其他预后参数。这些建议是由国际妇科病理学家协会子宫内膜癌项目制定的。
