子宫内膜癌分型的研究进展

Research Progress of Endometrial Cancer Classification

子宫内膜癌(endometrial carcinoma)是妇科三大恶性肿瘤之一,以手术联合放、化疗为标准治疗方式;部分渴望保留生育能力的患者可经咨询后行保守治疗,待生育后进行手术。1983年,Bockman提出子宫内膜癌临床分型,将其分为Ⅰ型(雌激素依赖型)和Ⅱ型(非雌激素依赖型);1994年,Poulsen将子宫内膜癌按组织病理学分为腺癌、浆液性腺癌、黏液性腺癌、透明细胞癌、鳞状细胞癌、混合性癌和未分化癌;2013年,癌症基因组图谱(The Cancer Genome Atlas,TCGA)根据不同突变方式和拷贝数将子宫内膜癌分为4种,即POLE(DNA polymerase epsilon)突变型、微卫星不稳定高突变型、低拷贝数型和高拷贝数型。该分子分型对不同亚型患者的精准化治疗与预测患者预后具有重要指导意义。本文总结了子宫内膜癌的3种分型的优势与局限性及其临床意义。子宫内膜癌分型的不断完善,将有助于理解其预后的个体差异,指导治疗策略的选择,为精准医疗时代规范化、个体化、人性化的治疗奠定理论基础。

Endometrial carcinoma is one of the three major malignant tumors in gynecology. The standard treatment is surgery with/without radiotherapy and chemotherapy;for those who desire to retain their fertility can be treated conservatively after consultation and accomplish the operation after childbirth. In 1983, Bockman proposed clinical classification of endometrial cancer,which was divided into typeⅠ(estrogen-dependent) and typeⅡ(non-estrogen-dependent);in 1994, Poulsen classified endometrial cancer into adenocarcinoma, serous adenocarcinoma, mucinous adenocarcinoma, clear cell carcinoma, squamous cell carcinoma,mixed carcinoma, and undifferentiated carcinoma by histopathology;in 2013, endometrial carcinoma was divided into four types based on different mutation patterns and copy number by the Cancer Genome Atlas(TCGA): polymerase epsilon(POLE) mutated,microsatellite instability, copy number-low and copy number-high. The molecular classification has important guiding significance for the precise treatment of patients with different subtypes and prognosis prediction of patients. In this review, we summarize three classifications of endometrial carcinoma, list their advantages and limitations, and highlight the clinical significance of endometrial cancer. The continuous improvement of classification of endometrial cancer will help to understand the heterogeneity in prognosis,guide the choice of treatment strategies, and lay a theoretical foundation for standardized, individualized and humanized treatment in the era of precision medicine.