Uterine-Conserving Treatment Options for Atypical Endometrial Hyperplasia and Early Endometrial Cancer.

IF 4.7 2区 医学 Q1 ONCOLOGY Current Oncology Reports Pub Date : 2024-10-03 DOI:10.1007/s11912-024-01603-9
Naomi N Adjei, Mikayla Borthwick Bowen, Roni Nitecki Wilke, Melinda S Yates, Shannon N Westin
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Abstract

Purpose of review: 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.

Recent findings: 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.

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非典型子宫内膜增生症和早期子宫内膜癌的保宫治疗方案。
综述目的:本综述旨在综述有关非典型子宫内膜增生症和1级子宫内膜癌的保宫治疗方案的现有文献,同时强调尚未解答的问题:随着年轻患者或无法接受手术治疗的患者人数不断增加,对非典型子宫内膜增生症和1级子宫内膜癌的保宫治疗方案的需求也在不断增长。我们回顾了与治疗非典型子宫内膜增生和 1 级子宫内膜癌的内分泌疗法相关的肿瘤和生殖结局。育龄人群中推迟生育、肥胖和糖尿病的发病率以及与高手术风险相关的内科合并症的发病率不断上升,继续扩大了对保全子宫疗法的需求。为了最大限度地提高治疗效果,必须为此类疗法选择合适的患者。非典型子宫内膜增生或早期低级别子宫内膜癌患者,且无子宫肌层受侵或宫外疾病的证据,是理想的候选者。目前最被接受的保守治疗方法是激素治疗和严密监测,在生育或治疗失败后可进行或不进行子宫切除术。需要进一步开展前瞻性和随机试验,以确定最佳患者和治疗方法的选择,并利用分子图谱进行个体化治疗和预后分析。
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来源期刊
CiteScore
8.50
自引率
0.00%
发文量
187
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published clinical findings in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by cancer. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as cancer prevention, leukemia, melanoma, neuro-oncology, and palliative medicine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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