Obermair Andreas, Baxter Eva, Brennan Donal J, McAlpine Jessica N, Muellerer Jennifer J, Amant Frédéric, van Gent Mignon D J M, Coleman Robert L, Westin Shannon N, Yates Melinda S, Krakstad Camilla, Janda Monika
Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Australia.
Department of Gynaecological Oncology, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Ireland.
Obstet Gynecol Sci. 2020 Jul;63(4):417-431. doi: 10.5468/ogs.19169. Epub 2020 Jul 8.
Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show rising incidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but 14-25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age and hyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC, which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularly for low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish to preserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, rising EC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservative non-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible and safe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safety of conservative management strategies are primarily based on retrospective studies. Randomized clinical trials in younger women and high-risk obese patients are currently underway. Here, we have presented a comprehensive review of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates and evaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have also summarized current guidelines and recommendations based on the published literature.
子宫内膜癌（EC）是全球女性中第五大常见癌症。全球估计显示，发达国家和发展中国家的发病率均呈上升趋势。大多数女性在绝经后被诊断出患有此病，但14%-25%的患者为绝经前患者，5%的患者年龄在40岁以下。已确定的风险因素包括年龄以及与未生育、肥胖和代谢综合征相关的高雌激素状态。EC的标准治疗方法包括全子宫切除术和双侧输卵管卵巢切除术，其生存结果良好，尤其是对于低级别子宫内膜样肿瘤。然而，这会导致希望保留生育能力的女性永久性丧失生育能力。随着育龄女性推迟生育、EC发病率上升以及肥胖流行加剧（尤其是在发达国家），保守非手术治疗方法的研究仍然是首要任务。保留生育功能的治疗主要包括使用口服孕激素和左炔诺孕酮宫内节育器，这些方法已被证明在早期EC且肌层侵犯最小或无肌层侵犯的女性中是可行且安全的。然而，保守治疗策略的疗效和安全性数据主要基于回顾性研究。针对年轻女性和高危肥胖患者的随机临床试验目前正在进行中。在此，我们对当前关于保守、保留生育功能方法的文献进行了全面综述，确定了最佳候选者，并评估了肿瘤特征、生殖和肿瘤学结局以及正在进行的临床试验。我们还根据已发表的文献总结了当前的指南和建议。
