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老年子宫内膜癌:特征、预后及危险因素和治疗选择。

Endometrial cancer in the elderly: Characteristics, prognostic and risk factors, and treatment options.

作者信息

Forte Miriam, Cecere Sabrina Chiara, Di Napoli Marilena, Ventriglia Jole, Tambaro Rosa, Rossetti Sabrina, Passarelli Anna, Casartelli Chiara, Rauso Martina, Alberico Gennaro, Mignogna Chiara, Fiore Francesco, Setola Sergio Venanzio, Troiani Teresa, Pignata Sandro, Pisano Carmela

机构信息

Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Campania, Italy.

Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples 80138, Italy.

出版信息

Crit Rev Oncol Hematol. 2024 Dec;204:104533. doi: 10.1016/j.critrevonc.2024.104533. Epub 2024 Oct 22.

Abstract

Endometrial cancer incidence and related mortality are on the rise due to aging demographics. This population often presents with unfavorable features, such as myometrial invasion, non-endometrioid histology, high-grade tumors, worse prognosis, etc. The role of age as an independent prognostic factor is still debated, and screening tools addressing frailty emerge as pivotal in guiding treatment decisions; however, they are still underutilized. Treatment disparities are evident in the case of older patients with endometrial cancer, who frequently receive suboptimal care, hindering their survival. Radiotherapy and minimally invasive surgical approaches could be performed in older patients. Data on chemotherapy and immunotherapy are scarce, but their potential remains promising and data are being gathered by recent trials, contingent on optimal patient selection through geriatric assessments. Overall, we recommend personalized, screening tool-guided approaches, adherence to guideline-recommended treatments, and inclusion of older people in clinical trials to help identify the best course of treatment.

摘要

由于人口老龄化,子宫内膜癌的发病率和相关死亡率正在上升。这一人群通常具有一些不利特征,如肌层浸润、非子宫内膜样组织学、高级别肿瘤、预后较差等。年龄作为独立预后因素的作用仍存在争议,针对虚弱状况的筛查工具在指导治疗决策中起着关键作用;然而,这些工具仍未得到充分利用。老年子宫内膜癌患者的治疗差异明显,他们经常接受不充分的治疗,这阻碍了他们的生存。老年患者可以接受放疗和微创手术。关于化疗和免疫治疗的数据很少,但其潜力仍然很大,最近的试验正在收集相关数据,这取决于通过老年评估进行的最佳患者选择。总体而言,我们建议采用个性化的、筛查工具指导的方法,坚持指南推荐的治疗方法,并将老年人纳入临床试验,以帮助确定最佳治疗方案。

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