Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, Houston, TX 77030, CPB6.3279, USA.
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA.
Curr Oncol Rep. 2024 Nov;26(11):1367-1379. doi: 10.1007/s11912-024-01603-9. Epub 2024 Oct 3.
This review aims to synthesize available literature on uterine-conserving treatment options for atypical endometrial hyperplasia and grade 1 endometrial carcinoma while highlighting remaining unanswered questions.
The need for uterine-conserving treatment options for atypical endometrial hyperplasia and grade 1 endometrial carcinoma is growing with the increasing number of cases in younger patients or those who cannot undergo surgery. We reviewed the oncological and reproductive outcomes associated with endocrine therapies used for atypical endometrial hyperplasia and grade 1 endometrial carcinoma. The rising prevalence of delayed childbearing, obesity, and diabetes in reproductive-age individuals and of medical comorbidities associated with high surgical risk continues to amplify the demand for uterine-conserving therapies. Appropriate patient selection for such therapies is imperative to maximize likelihood of treatment response. The ideal candidates are patients with atypical endometrial hyperplasia or early-stage, low-grade endometrial cancer with no evidence of myometrial invasion or extrauterine disease. The most accepted conservative therapeutic approach is hormonal therapy with close surveillance, with or without eventual hysterectomy following childbearing or failure of treatment. Further prospective and randomized trials are needed to address optimal patient and treatment selection, as well as the use of molecular profiling for treatment individualization and prognostication.
本文旨在综合目前关于非典型子宫内膜增生和 1 级子宫内膜癌的保留子宫治疗选择的文献，同时强调仍存在未解决的问题。
随着年轻患者或不能手术的患者中非典型子宫内膜增生和 1 级子宫内膜癌的数量不断增加，对保留子宫治疗选择的需求也在不断增加。我们回顾了用于非典型子宫内膜增生和 1 级子宫内膜癌的内分泌治疗的肿瘤学和生殖结局。由于生育期人群中生育延迟、肥胖和糖尿病的发病率上升，以及与高手术风险相关的医疗合并症不断增加，对保留子宫治疗的需求也在不断增加。适当选择此类治疗的患者对于最大限度地提高治疗反应的可能性至关重要。理想的患者是患有非典型子宫内膜增生或早期低级别子宫内膜癌且无肌层浸润或子宫外疾病证据的患者。最被接受的保守治疗方法是激素治疗，并密切监测，伴或不伴生育后或治疗失败后的子宫切除术。需要进一步的前瞻性和随机试验来解决最佳患者和治疗选择，以及使用分子谱分析进行个体化治疗和预后预测的问题。
