Gallo Alessandra, Catena Ursula, Saccone Gabriele, Di Spiezio Sardo Attilio
Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy.
Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
J Clin Med. 2021 Dec 29;11(1):183. doi: 10.3390/jcm11010183.
Endometrial cancer (EC) is the sixth most common female cancer worldwide. The median age of diagnosis is 65 years. However, 4% of women diagnosed with EC are younger than 40 years old, and 70% of these women are nulliparous. These data highlight the importance of preserving fertility in these patients, at a time when the average age of the first pregnancy is significantly delayed and is now firmly established at over 30 years of age. National Comprehensive Cancer Network (NCCN guidelines state that the primary treatment of endometrial endometrioid carcinoma, limited to the uterus, is a total hysterectomy, bilateral salpingo-oophorectomy and surgical staging. Fertility-sparing treatment is not the standard of care, and patients eligible for this treatment always have to undergo strict counselling. Nowadays, a combined approach consisting of hysteroscopic resection, followed by oral or intrauterine-released progestins, has been reported to be an effective fertility-sparing option. Hysteroscopic resection followed by progestins achieved a complete response rate of 95.3% with a recurrence rate of 14.1%. The pregnancy rate in women undergoing fertility-sparing treatment is 47.8%, but rises to 93.3% when only considering women who tried to conceive during the study period. The aim of the present review is to provide a literature overview reflecting the current state of fertility-sparing options for the management of EC, specific criteria for considering such options, their limits, the implications for reproductive outcomes and the latest research trends in this direction.
子宫内膜癌（EC）是全球第六大常见的女性癌症。诊断的中位年龄为65岁。然而，4%被诊断为EC的女性年龄小于40岁，其中70%为未生育女性。这些数据凸显了在这些患者中保留生育能力的重要性，此时首次怀孕的平均年龄显著推迟，现已稳固地超过30岁。美国国立综合癌症网络（NCCN）指南指出，局限于子宫的子宫内膜样癌的主要治疗方法是全子宫切除术、双侧输卵管卵巢切除术和手术分期。保留生育功能的治疗并非标准治疗方式，符合该治疗条件的患者必须始终接受严格的咨询。如今，据报道，一种由宫腔镜切除术，随后口服或宫腔内释放孕激素组成的联合方法是一种有效的保留生育功能的选择。宫腔镜切除术后使用孕激素的完全缓解率为95.3%，复发率为14.1%。接受保留生育功能治疗的女性的妊娠率为47.8%，但仅考虑在研究期间尝试受孕的女性时，妊娠率升至93.3%。本综述的目的是提供一篇文献综述，反映目前用于管理EC的保留生育功能选择的现状、考虑此类选择的具体标准、其局限性、对生殖结局的影响以及该方向的最新研究趋势。
