早期子宫内膜样腺癌的保留生育功能治疗  

Fertility-sparing therapy in young women with early stage endometrioid carcinoma

作　　者：单波儿[1] 王华英[1] 

机构地区：[1]复旦大学附属肿瘤医院妇瘤科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2012年第8期622-626,共5页China Oncology

摘　　要：早期子宫内膜癌保留生育功能的治疗是妇瘤科医生面临的一个挑战。醋酸甲羟孕酮(200～800 mg/d)以及醋酸甲地孕酮(10～400 mg/d)是最常用的药物,中位治疗6个月后50%的患者治愈,约25%的患者初治无效,另有25%的患者完全缓解后复发,治疗失败者多和肌层浸润、组织分化较差、宫颈累及、卵巢转移或同时并发卵巢原发性恶性肿瘤相关。因此必须严格掌握治疗指征,治疗前进行严格评估,包括超声、增强MRI以及宫腹腔镜联合检查排除子宫肌层浸润和子宫外转移。同时,患者必须充分了解保守治疗相关风险并愿意密切随访。建议治愈并完成生育功能的患者尽早行根治性手术。复发患者可再次应用激素治疗或行根治性手术。Endometrial cancer in young and especially null gravid women is a challenging problem with increasing frequency for women delaying their plans for pregnancy. It is a complicated situation when a physician encounters a request from a patient with early stage endometrial cancer or her family concerning whether she could conceive a child prior to a definite cancer treatment. Despite being an interesting issue, there is no standard treatment algorithm and practice is mainly based on case reports and series or very few prospective studies. The most commonly used agents are oral medroxyprogesterone acetate （MPA） and megestrol acetate （MA） given at daily dosage from 200- 800 mg and 10-400 mg, respectively. Overall, nearly 50% patients demonstrated a complete response to hormonal therapy with no evidence of recurrence, 25% patients exhibited an initial response but eventually developed a recurrence, and 25% experienced persistent disease. Risk factors detected for treatment failure were myometrial invasion, cervical involvement, grade 2 tumor, coexisting ovarian cancer, or extrauterine disease. Thus, maximum efforts to assess of the extent of disease should be carried out prior to conservative treatment, and the details of the cancer prognosis and plan of treatment should be thoroughly discussed with the patient and relevant family members. Definitive treatment with hysterectomy/bilateral salpingoophorectomy （and staging if necessary） should be performed after completion of childbearing or for patients with recurrence or persistent disease. However, recurrences may be retreated with the same or different hormonal agents at the same or increased dose, or combined with other agents. Further evaluation with large prospective or randomized trials with uniform hormonal therapy is necessary to define the most effective treatment regimen and further stratify women according to the risk of treatment failure.

关 键 词：子宫内膜癌 保留生育功能 孕激素 

分 类 号：R737.33[医药卫生—肿瘤]