微卫星不稳定型子宫内膜癌的临床特点和治疗

Clinical Characteristics and Treatment of Microsatellite Instability Type of Endometrial Cancer

子宫内膜癌(endometrial cancer,EC)近年发病率呈上升趋势,传统的病理组织分型不能精准地指导患者的个体化治疗及评估预后,基于分子生物学技术提出的EC分子分型应运而生,这种分子分型在EC患者术后放化疗、免疫治疗及靶向治疗中均具有重要的指导作用。其中,微卫星不稳定(microsatellite instability,MSI)型EC为癌症基因组图谱(The Cancer Genome Atlas,TCGA)分子分型中的一种,MSI型EC具有独特的临床特征和病理学特征,并且在治疗及预后方面也与其他分型的EC较为不同。分子分型现已整合到欧洲妇科肿瘤学会指南中,研究表明,MSI型EC患者化疗获益不高,但受益于免疫治疗,现已推荐使用免疫治疗联合抗血管生成药物治疗。目前关于MSI型EC患者的病理特点、预后和治疗方面仍存在一些争议,对MSI型EC患者的几项药物联合治疗仍在研究中,在EC患者中根据分子分型进行个体化治疗已成为研究的重点。

In recent years,the incidence of endometrial cancer(EC) has been on the rise,and the traditional pathological tissue typing cannot accurately guide the individual treatment and evaluate the prognosis of patients.The molecular typing of EC based on molecular biology technology came into being.This molecular typing has an important guiding role in postoperative chemoradiotherapy,immunotherapy and targeted therapy for EC patients.The microsatellite instability(MSI) type of EC is one of the molecular types of The Cancer Genome Atlas(TCGA).MSI type of EC has unique clinical and pathological features.In addition,it is different from other types of EC in terms of treatment and prognosis.Molecular classification has been integrated into the Guideline from European Society of Gynaecological Oncology.Recent studies have shown that the patients with MSI type of EC do not get more benefit from chemotherapy,but they can get benefits from immunotherapy.The immune therapy combined with anti-angiogenesis drugs therapy has been recommended for those patients.However,there are still some controversy on the pathological characteristics,prognosis and therapy of MSI type of EC.Several therapy protocols of the combined drugs are still under study.It is true that the individualized treatment according to the molecular classification of EC will be the research focus.