Popat Vinita, Han Ernest
Division of Gynecologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
Curr Treat Options Oncol. 2025 Sep 5. doi: 10.1007/s11864-025-01346-0.
Ovarian cancer, particularly high-grade serous carcinoma (HGSC), remains a leading cause of mortality in gynecologic oncology. Emerging research identifies serous tubal intraepithelial carcinoma (STIC) as a precursor lesion in many HGSC cases, highlighting its role in ovarian cancer pathogenesis and prevention. Management of STIC is challenging, as there is only limited data available to guide clinical decision-making. For average-risk women, opportunistic salpingectomy is increasingly being adopted during routine procedures such as hysterectomy or cesarean section. This intervention has demonstrated significant potential in reducing ovarian cancer incidence while maintaining safety and feasibility. For high-risk individuals, particularly BRCA mutation carriers, risk-reducing salpingo-oophorectomy (RRSO) remains the gold standard. RRSO significantly lowers ovarian cancer risk, though alternative approaches like salpingectomy alone or radical fimbriectomy are under investigation to preserve ovarian function in younger patients. To improve STIC detection, SEE-FIM pathology protocol is recommended when patients are undergoing risk-reducing surgery to prevent ovarian cancer, but challenges such as diagnostic variability and limited data persist. When STIC is detected incidentally, management varies based on risk factors and lesion characteristics. Genetic counseling and testing are essential when STIC is identified, as hereditary predisposition may guide further management. Surgical management is advised for cases of STIC with microinvasive carcinoma, but routine use of surgical management for STIC is not clearly defined in the literature. Bilateral oophorectomy is generally recommended when STIC is identified, and adnexal structures have not yet been removed. Chemotherapy is not recommended for treatment of STIC. Surveillance is suggested when STIC has been diagnosed, but there are no set guidelines as to the frequency and type of monitoring. Future directions include refining molecular profiling to predict progression and conducting randomized studies to establish evidence-based guidelines. Multidisciplinary collaboration is essential to optimize prevention and treatment, ultimately reducing HGSC incidence and improving patient outcomes.
卵巢癌，尤其是高级别浆液性癌（HGSC），仍然是妇科肿瘤学中导致死亡的主要原因。新出现的研究将输卵管上皮内浆液性癌（STIC）确定为许多HGSC病例中的前驱病变，凸显了其在卵巢癌发病机制和预防中的作用。STIC的管理具有挑战性，因为仅有有限的数据可用于指导临床决策。对于平均风险的女性，在子宫切除术或剖宫产等常规手术过程中越来越多地采用机会性输卵管切除术。这种干预措施在降低卵巢癌发病率的同时，保持了安全性和可行性，已显示出巨大潜力。对于高危个体，尤其是携带BRCA突变的人，降低风险的输卵管卵巢切除术（RRSO）仍然是金标准。RRSO可显著降低卵巢癌风险，不过，为保留年轻患者的卵巢功能，正在研究单独输卵管切除术或根治性输卵管伞端切除术等替代方法。为提高STIC的检测率，建议在患者接受降低风险的手术以预防卵巢癌时采用SEE-FIM病理方案，但诊断变异性和数据有限等挑战依然存在。当偶然发现STIC时，管理方式会根据风险因素和病变特征而有所不同。当识别出STIC时，遗传咨询和检测至关重要，因为遗传易感性可能指导进一步的管理。对于伴有微浸润癌的STIC病例，建议进行手术管理，但文献中对于STIC常规使用手术管理并未明确界定。当识别出STIC且附件结构尚未切除时，一般建议进行双侧卵巢切除术。不建议使用化疗治疗STIC。当诊断出STIC时，建议进行监测，但对于监测的频率和类型尚无既定指南。未来的方向包括完善分子谱分析以预测进展，并开展随机研究以建立循证指南。多学科合作对于优化预防和治疗至关重要，最终可降低HGSC的发病率并改善患者预后。
