Leone Roberti Maggiore Umberto, Khamisy-Farah Rola, Bragazzi Nicola Luigi, Bogani Giorgio, Martinelli Fabio, Lopez Salvatore, Chiappa Valentina, Signorelli Mauro, Ditto Antonino, Raspagliesi Francesco
Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy.
Clalit Health Service, Akko, Azrieli Faculty of Medicine, Bar-Ilan University, Safed 13100, Israel.
J Clin Med. 2021 Oct 19;10(20):4784. doi: 10.3390/jcm10204784.
Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries. Although it is more common in postmenopausal women, it may affect up to 25% in the premenopausal age and 3-5% under the age of 40 years. Furthermore, in the last decades a significant shift to pregnancy at older maternal ages, particularly in resource-rich countries, has been observed. Therefore, in this scenario fertility-sparing alternatives should be discussed with patients affected by EC. This study summarizes available literature on fertility-sparing management of patients affected by EC, focusing on the oncologic and reproductive outcomes. A systematic computerized search of the literature was performed in two electronic databases (PubMed and MEDLINE) in order to identify relevant articles to be included for the purpose of this systematic review. On the basis of available evidence, fertility-sparing alternatives are oral progestins alone or in combination with other drugs, levonorgestrel intrauterine system and hysteroscopic resection in association with progestin therapies. These strategies seem feasible and safe for young patients with G1 endometrioid EC limited to the endometrium. However, there is a lack of high-quality evidence on the efficacy and safety of fertility-sparing treatments and future well-designed studies are required.
子宫内膜癌（EC）目前是发达国家女性生殖道最常见的恶性肿瘤。尽管它在绝经后女性中更为常见，但在绝经前女性中其发病率可能高达25%，在40岁以下女性中为3% - 5%。此外，在过去几十年中，尤其是在资源丰富的国家，观察到产妇年龄较大时怀孕的显著转变。因此，在这种情况下，应该与患有EC的患者讨论保留生育功能的替代方案。本研究总结了关于EC患者保留生育功能管理的现有文献，重点关注肿瘤学和生殖结局。为了确定纳入本系统评价的相关文章，在两个电子数据库（PubMed和MEDLINE）中进行了系统的计算机文献检索。根据现有证据，保留生育功能的替代方案有单独使用口服孕激素或与其他药物联合使用、左炔诺孕酮宫内节育系统以及与孕激素治疗联合的宫腔镜切除术。这些策略对于局限于子宫内膜的G1级子宫内膜样EC的年轻患者似乎是可行且安全的。然而，关于保留生育功能治疗的疗效和安全性缺乏高质量证据，需要未来设计良好的研究。
