John Radcliffe Hospital, Oxford, UK.
Campus Bio-Medico University of Rome, Italy.
Maturitas. 2020 Apr;134:56-61. doi: 10.1016/j.maturitas.2020.01.005. Epub 2020 Feb 11.
Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569,847, corpus uteri 382,069, ovary 295,414, vulva 44,235 and vagina 17,600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45, early menopause.
The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer.
Literature review and consensus of expert opinion.
The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal or vulvar cancer, as these tumors are not considered to be hormone dependent.
据估计，全球每年新诊断出约 130 万例妇科癌症病例。2018 年，预计每年的总数为子宫颈癌 569847 例、子宫体癌 382069 例、卵巢癌 295414 例、外阴癌 44235 例和阴道癌 17600 例。治疗方法包括子宫切除术伴或不伴双侧输卵管卵巢切除术、放疗和化疗。这些治疗方法可能导致卵巢功能丧失，对于 45 岁以下的女性，会导致早绝经。
本立场声明的目的是制定一种个体化的治疗方法，包括是否使用绝经激素治疗，以管理妇科癌症患者的绝经症状和预防及治疗骨质疏松症。
文献回顾和专家意见共识。
有限的数据表明，低级别、早期子宫内膜癌患者可能会考虑全身或局部雌激素治疗。然而，绝经激素治疗可能会刺激疾病进展期患者的肿瘤生长，因此推荐使用非激素方法。子宫肉瘤可能依赖于激素，因此应进行雌激素和孕激素受体检测，以指导是否使用绝经激素治疗或非激素策略。现有有限证据表明，绝经激素治疗（全身或局部）似乎不会对非浆液性上皮性卵巢癌和生殖细胞肿瘤患者造成伤害，也不会降低总生存率或无病生存率。由于其激素依赖性，对于浆液性和颗粒细胞瘤患者，应谨慎使用全身和局部绝经激素治疗，建议采用非激素治疗作为初始治疗。对于宫颈、阴道或外阴癌患者，没有证据表明使用全身或局部绝经激素治疗会产生不良影响，因为这些肿瘤不被认为是激素依赖性的。
