晚期及复发性子宫内膜癌治疗进展

Progress of treatment of an advanced and recurrent endometrial uterine carcinoma

晚期和复发性子宫内膜癌的预后较差,本文对文献中有关晚期和复发子宫内膜癌的治疗和预后的资料进行整理分析,尝试找到提高该类患者生存率的有效办法.结果如下：手术是子宫内膜癌的首选治疗方式.对肿瘤累及宫颈间质的患者施行根治性子宫切除可能疗效更佳;对中、高危尤其是特殊类型的患者,进行腹膜后淋巴结清扫可改善预后;对特殊病理类型患者建议切除大网膜;对晚期和复发患者满意的肿瘤细胞减灭术是延长生存期的重要手段.经腹腔镜或机器人全面分期手术适用于没有盆腹腔扩散的患者,对已有盆腹腔扩散的患者,开腹手术仍是首选.对高危和晚期患者,术后辅助放化疗效果更佳.术后辅助化疗应用于高危、晚期和复发患者.靶向治疗和内分泌治疗对晚期和复发患者具有一定的疗效.

The purpose of the current study was to detect the potential therapeutic role of a survival benefit for women with advanced and recurrent endometrial carcinoma for their poor prognosis.A number of published studies for women with advanced and recurrent endometrial cancers were reviewed.We found that surgery had been the primary treatment of choice for an endometrial carcinoma.Where disease has spread to the uterine cervix,extended or radical surgery may be curative.The systematic lymph node resection improves the survival of women with intermediate/high-risk endometrioid uterine cancer,especially non-endometrioid carcinoma.The omentectomy may be beneficial for non-endometrioid cancer.A number of studies report a survival benefit from surgical cytoreduction in women with advanced and recurrent disease,although the degree of surgical effort is required in order to achieve an optimal result varies.Laparoscopic and robotic surgical staging for uterine cancer might be considered as a standard of care for endometrial cancer without extra-uterine metastasis.Laparotomy should be the first choice for extra-uterine metastasis and recurrent disease.Adjuvant radiotherapy and chemotherapy have a potential role in the management of high-risk,advanced,and recurrent disease.Efficacy of targeted and endocrinal treatment in women with advanced and recurrent endometrial cancer has been proved.