Centini Gabriele, Colombi Irene, Ianes Ilaria, Perelli Federica, Ginetti Alessandro, Cannoni Alberto, Habib Nassir, Negre Ramon Rovira, Martire Francesco Giuseppe, Raimondo Diego, Lazzeri Lucia, Zupi Errico
Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy.
Pediatric Gynecology Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy.
Cancers (Basel). 2025 Jan 1;17(1):112. doi: 10.3390/cancers17010112.
Endometrial cancer is the most common gynecological neoplasm with an increased incidence in the premenopausal population in recent decades. This raises the problem of managing endometrial cancer in fertile women who have not yet achieved pregnancy. In these women, after careful selection, hysterectomy may be postponed in favor of conservative management if specific requirements are met. The latest evidence is focused on early endometrial carcinoma, endometrioid histotype, Grading 1, with no evidence of myometrial infiltration. Few clinical trials have opened this possibility also for women with an endometrial cancer Grading 2 diagnosis. There are still questions about the best medical therapy, dosage, route, and duration of treatment. Oral progestins or levonorgestrel-releasing intrauterine devices appear to be the options associated with the best outcome in terms of complete response and lower recurrence rates. Other options include the use of GnRH analogues, surgical hysteroscopy, or metformin, in a therapeutic approach that takes into account the characteristics of the patient. The pursuit of pregnancy should start as soon as two consecutive endometrial biopsies are obtained 3 months apart from each other; it is recommended to refer the patients to ART centers to maximize the success rate. After having reached the fulfillment of the reproductive desire, surgical radical treatment is still recommended.
子宫内膜癌是最常见的妇科肿瘤，近几十年来绝经前人群的发病率有所上升。这就引发了如何处理尚未怀孕的育龄期子宫内膜癌患者的问题。对于这些女性，经过仔细筛选，如果符合特定要求，子宫切除术可能会被推迟，转而采取保守治疗。最新证据聚焦于早期子宫内膜癌、子宫内膜样组织学类型、1级、无肌层浸润证据的患者。很少有临床试验也为诊断为2级子宫内膜癌的女性开启这种可能性。关于最佳药物治疗、剂量、给药途径和治疗持续时间仍存在疑问。口服孕激素或左炔诺孕酮宫内节育器似乎是在完全缓解和较低复发率方面与最佳结果相关的选择。其他选择包括使用促性腺激素释放激素类似物、手术宫腔镜检查或二甲双胍，治疗方法需考虑患者的特征。一旦相隔3个月连续获得两次子宫内膜活检结果，就应尽快开始备孕；建议将患者转诊至辅助生殖中心以提高成功率。在实现生育愿望后，仍建议进行根治性手术治疗。
