孕激素在子宫内膜癌和非典型子宫内膜增生保留生育力中的应用

Application of progesterone in preserving fertility in endometrial cancer and atypical endometrial hyperplasia

子宫内膜癌(endometrial cancer)和非典型子宫内膜增生(atypical endometrial hyperplasia)患者的发病逐渐年轻化,当前生育年龄又普遍延迟,使得这类患者对保留生育力的治疗产生重大需求。作为中国妇科第2大恶性肿瘤,其标准治疗是全子宫和双侧附件切除术,然而这会导致永久不孕。孕激素对早期子宫内膜癌和非典型子宫内膜增生治疗效果良好且不会破坏生育力。保育患者的筛选标准已有指南给出推荐。口服醋酸甲地孕酮(megestrolacetate)、醋酸甲羟孕酮(medroxyprogesterone acetate)是目前最常用的保育方案,左炔诺孕酮(levonorgestrel)宫内节育器作为局部孕激素疗法同样不可忽视。此外,孕激素药物与二甲双胍(metformin)、促性腺激素释放激素激动剂等药物的联合使用研究正在不断开展。面对现有治疗方案的局限性,积极寻找治疗及预后标志物,探索治疗新方法同样重要。

The onset of endometrial cancer and atypical endometrial hyperplasia is gradually becoming younger,and the current childbearing age is generally delayed,which makes these patients have a great demand for fertility sparing treatment.As the second most common gynecological malignancy in China,the standard treatment is total hysterectomy and bilateral adnexectomy,which leads to permanent infertility.Progesterone is effective in the treatment of early-stage endometrial cancer and atypical endometrial hyperplasia without destroying fertility.Screening criteria for these patients have been recommended in guidelines.Oral megestrol acetate and medroxyprogesterone acetate are the most commonly used fertility sparing treatments,levonorgestrel-releasing intrauterine devices,as a local progesterone therapy,can not be ignored.In addition,studies on the combination of progesterone drugs with metformin and gonadotropin releasing hormone agonist are being carried out.Facing the limitations of existing treatment options,it is equally important to actively search for therapeutic and prognostic markers,and explore new treatment methods.