Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA.
Am J Obstet Gynecol. 2021 Jun;224(6):574-584. doi: 10.1016/j.ajog.2020.12.1213. Epub 2021 Jan 4.
In 2020, endometrial cancer continues to be the most common gynecologic malignancy in the United States. The majority of endometrial cancer is low grade, and nearly 1 of every 8 low-grade endometrial cancer diagnoses occurs in women younger than 50 years with early-stage disease. The incidence of early-stage, low-grade endometrial cancer is increasing particularly among women in their 30s. Women with early-stage, low-grade endometrial cancer generally have a favorable prognosis, and hysterectomy-based surgical treatment alone can often be curative. In young women with endometrial cancer, consideration of ovarian conservation is especially relevant to avoid both the short-term and long-term sequelae of surgical menopause including menopausal symptoms, cardiovascular disease, metabolic disease, and osteoporosis. Although disadvantages of ovarian conservation include failure to remove ovarian micrometastasis (0.4%-0.8%), gross ovarian metastatic disease (4.2%), or synchronous ovarian cancer (3%-5%) at the time of surgery and the risk of future potential metachronous ovarian cancer (1.2%), ovarian conservation is not negatively associated with endometrial cancer-related or all-cause mortality in young women with early-stage, low-grade endometrial cancer. Despite this, utilization of ovarian conservation for young women with early-stage, low-grade endometrial cancer remains modest with only a gradual increase in uptake in the United States. We propose a framework and strategic approach to identify young women with early-stage, low-grade endometrial cancer who may be candidates for ovarian conservation. This evidence-based schema consists of a 2-step assessment at both the preoperative and intraoperative stages that can be universally integrated into practice.
2020 年，子宫内膜癌仍然是美国最常见的妇科恶性肿瘤。大多数子宫内膜癌为低级别，每 8 例低级别子宫内膜癌诊断中就有 1 例发生在年龄小于 50 岁且疾病处于早期的女性。早期低级别子宫内膜癌的发病率，尤其是在 30 多岁的女性中，正在上升。早期低级别子宫内膜癌患者的预后通常较好，单独进行以子宫切除术为基础的手术治疗通常可以治愈。对于患有子宫内膜癌的年轻女性，考虑卵巢保留术特别重要，可以避免手术性绝经的短期和长期后果，包括绝经症状、心血管疾病、代谢疾病和骨质疏松症。尽管保留卵巢存在一些缺点，包括无法切除卵巢微转移灶（0.4%-0.8%）、卵巢广泛转移病灶（4.2%）或手术时同步发生卵巢癌（3%-5%）以及未来可能发生卵巢癌异时性转移的风险（1.2%），但在早期低级别子宫内膜癌的年轻女性中，保留卵巢与子宫内膜癌相关或全因死亡率无不良关联。尽管如此，在美国，保留卵巢用于早期低级别子宫内膜癌的年轻女性的应用仍然适度，只有在美国，其使用率才逐渐增加。我们提出了一个框架和策略性方法，以确定可能适合保留卵巢的早期低级别子宫内膜癌年轻女性。该基于证据的方案包括术前和术中的两步评估，可以普遍整合到实践中。
