Endometrial Cancer
Endometrial Cancer
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DOI：
10.1097/aog.0b013e3182605bf1
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发表时间：
2012-08-01
影响因子：
7.2
通讯作者：
Sorosky, Joel I.
中科院分区：
文献类型：
--
作者：
Sorosky, Joel I.
本文就子宫内膜癌的流行病学、预防、诊断、治疗、预后及国际妇产科联合会新的分期系统作一综述。自2008年以来，子宫内膜癌的发病率增加了21%，死亡率在过去二十年中增加了100%以上。在超过40%的病例中，伴有子宫内膜异位症的复杂性增生的前驱病变与子宫内膜癌相关。子宫内膜癌在白色妇女中的发生率是黑人妇女的两倍，但是，分期，黑人妇女的预后较差。术前影像学不能准确评估淋巴结受累。大体检查子宫肌层浸润深度对于选择可以安全地从外科手术中省略淋巴结切除术的妇女没有敏感性、特异性、阳性预测值或阴性预测值。虽然手术分期仍然是确定疾病范围最准确的方法，盆腔淋巴结清扫术的治疗价值尚未确定。淋巴结切除术的解剖范围和切除的淋巴结数量以确定预后和治疗益处是有争议的。研究工作的目的是确定早期子宫内膜癌的妇女谁只需要全子宫切除术和双侧输卵管卵巢切除术。微创手术技术已成为治疗子宫内膜癌妇女的标准疗法。有遗传性非息肉病性结直肠癌家族史的妇女患子宫内膜癌的风险增加。在某些情况下，允许生育的保守治疗是可能的。患有子宫内膜癌的妇女应该由在这种疾病的复杂的多模式治疗方面有经验的医生管理。（Obstet Gynecol 2012;120：383-97）DOI：10.1097/AOG.0b013e3182605bf1
The epidemiology, prevention, diagnosis, treatment, prognosis, and new International Federation of Gynecology and Obstetrics staging system of endometrial carcinoma are reviewed. Endometrial cancer has increased 21% in incidence since 2008, and the death rate has increased more than 100% over the past two decades. Precursor lesions of complex hyperplasia with atypia are associated with an endometrial carcinoma in more than 40% of cases. Endometrial cancer in white women occurs at twice the incidence as in black women, but, stage for stage, black women have a less favorable prognosis. Preoperative imaging cannot accurately assess lymph node involvement. Gross examination of depth of myometrial invasion does not have the sensitivity, specificity, positive predictive value, or negative predictive value to select women who can have lymphadenectomy safely omitted from the surgical procedure. Although surgical staging remains the most accurate method of determining the extent of disease, the therapeutic value of pelvic lymphadenectomy has not been established. The anatomical extent of lymphadenectomy and the number of lymph nodes removed to establish prognostic and therapeutic benefit are controversial. Research efforts are directed at identifying women with early stage endometrial cancer who only require total hysterectomy and bilateral salpingo-oophorectomy. Minimally invasive surgical techniques have become established as standard therapy for treating women with endometrial cancer. Women with a family history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Conservative treatment to allow for childbearing is possible in select situations. Women with endometrial cancer should be managed by physicians experienced in the complex multimodality treatment of this disease. (Obstet Gynecol 2012;120:383-97) DOI: 10.1097/AOG.0b013e3182605bf1