结合典型病例谈年轻子宫内膜癌患者生育功能的保留

doi:10.12280/gjfckx.20201056

摘要/Abstract

摘要：

随着全球女性生育年龄的推迟,年轻子宫内膜癌患者保留生育功能越来越受到重视,是近年来国内外研究的热点及重点。大多数早期的年轻子宫内膜癌多为雌激素依赖型,具有病变局限、进展缓慢、分化及预后较好、对性激素治疗反应良好等特点,高效、大剂量、长期应用孕激素是子宫内膜癌患者保留生育功能治疗成功的关键,安全有效的全面评估尤为重要,介绍1例治疗成功的典型病例,就此领域的最新进展进行详细阐述。

关键词: 子宫内膜肿瘤, 生育力, 宫腔镜, 孕激素类, 病例报告

Abstract:

With the postponement of the childbearing age of women worldwide, the preservation of fertility in young endometrial cancer patients has received more and more attention. Most early-stage young endometrial cancers are mostly estrogen-dependent, with limited lesions, slow progress, good differentiation and prognosis, and good response to sex hormone therapy. High-efficiency, high-dose, long-term use of progesterone is the key to the success of the treatment. The safe and effective comprehensive assessment is particularly important. This article takes the typical cases of successful treatment as a guide to elaborate on the latest developments in this field.

Key words: Endometrial neoplasms, Fertility, Hysteroscopes, Progestins, Case reports

朱诚程, 孙青, 金兰, 丁锦, 吕爰爰, 倪观太. 结合典型病例谈年轻子宫内膜癌患者生育功能的保留[J]. 国际妇产科学杂志, 2021, 48(4): 472-476.

ZHU Cheng-cheng, SUN Qing, JIN Lan, DING Jin, LYU Yuan-yuan, NI Guan-tai. Combining Typical Case to Discuss the Preservation of Fertility in Young Endometrial Cancer[J]. Journal of International Obstetrics and Gynecology, 2021, 48(4): 472-476.

参考文献 25

[1]	Wang Y, Yang JX. Fertility-preserving treatment in women with early endometrial cancer: the Chinese experience[J]. Cancer Manag Res, 2018, 10:6803-6813. doi: 10.2147/CMAR.S188087. doi: 10.2147/CMAR.S188087 pmid: 30584372
[2]	Tock S, Jadoul P, Squifflet JL, et al. Fertility Sparing Treatment in Patients With Early Stage Endometrial Cancer, Using a Combination of Surgery and GnRH Agonist: A Monocentric Retrospective Study and Review of the Literature[J]. Front Med (Lausanne), 2018, 5:240. doi: 10.3389/fmed.2018.00240. doi: 10.3389/fmed.2018.00240
[3]	李秋霞, 余贵媛. 年轻子宫内膜癌女性保留生育及卵巢功能的治疗进展[J]. 国际妇产科学杂志, 2018, 45(1):75-79. doi: 10.3969/j.issn.1674-1870.2018.01.016. doi: 10.3969/j.issn.1674-1870.2018.01.016
[4]	Jerzak KJ, Duska L, MacKay HJ. Endocrine therapy in endometrial cancer: An old dog with new tricks[J]. Gynecol Oncol, 2019, 153(1):175-183. doi: 10.1016/j.ygyno.2018.12.018. doi: 10.1016/j.ygyno.2018.12.018
[5]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018: 309.
[6]	Koh WJ, Abu-Rustum NR, Bean S, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2018, 16(2):170-199. doi: 10.6004/jnccn.2018.0006. doi: 10.6004/jnccn.2018.0006
[7]	中国研究型医院学会妇产科专业委员会. 早期子宫内膜癌保留生育功能治疗专家共识[J]. 中国妇产科临床杂志, 2019, 20(4):369-373. doi: 10.13390/j.issn.1672-1861.2019.04.025. doi: 10.13390/j.issn.1672-1861.2019.04.025
[8]	Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up[J]. Ann Oncol, 2016, 27(1):16-41. doi: 10.1093/annonc/mdv484. doi: 10.1093/annonc/mdv484 pmid: 26634381
[9]	陈琳, 陈思敬. 年轻子宫内膜癌患者保留生育功能治疗相关问题思考与探讨[J]. 现代妇产科进展, 2018, 27(7):545-548. doi: 10.13283/j.cnki.xdfckjz.2018.07.017. doi: 10.13283/j.cnki.xdfckjz.2018.07.017
[10]	刘剑英, 杨莹, 张颖, 等. 早期子宫内膜癌保留生育功能的治疗进展[J]. 实用妇科内分泌电子杂志, 2019, 15(6):14-15. doi: 10.16484/j.cnki.issn2095-8803.2019.15.008. doi: 10.16484/j.cnki.issn2095-8803.2019.15.008
[11]	王春延, 胡元晶. 早期子宫内膜癌患者保留生殖内分泌功能治疗的研究进展[J]. 国际妇产科学杂志, 2013, 40(3):247-250.
[12]	Wang Y, Yang JX. Fertility-preserving treatment in women with early endometrial cancer: the Chinese experience[J]. Cancer Manag Res, 2018, 10:6803-6813. doi: 10.2147/CMAR.S188087. doi: 10.2147/CMAR.S188087 pmid: 30584372
[13]	Falcone F, Laurelli G, Losito S, et al. Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer[J]. J Gynecol Oncol, 2017, 28(1):e2. doi: 10.3802/jgo.2017.28.e2. doi: 10.3802/jgo.2017.28.e2
[14]	Minig L, Franchi D, Boveri S, et al. Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women[J]. Ann Oncol, 2011, 22(3):643-649. doi: 10.1093/annonc/mdq463. doi: S0923-7534(19)38625-9 pmid: 20876910
[15]	Imterat M, Agarwal A, Esteves SC, et al. Impact of Body Mass Index on female fertility and ART outcomes[J]. Panminerva Med, 2019, 61(1):58-67. doi: 10.23736/S0031-0808.18.03490-0. doi: 10.23736/S0031-0808.18.03490-0 pmid: 29962181
[16]	Wang Y, Zhou R, Wang H, et al. Impact of treatment duration in fertility-preserving management of endometrial cancer or atypical endometrial hyperplasia[J]. Int J Gynecol Cancer, 2019, 29(4):699-704. doi: 10.1136/ijgc-2018-000081. doi: 10.1136/ijgc-2018-000081
[17]	Park JY, Kim DY, Kim JH, et al. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002)[J]. Eur J Cancer, 2013, 49(4):868-874. doi: 10.1016/j.ejca.2012.09.017. doi: 10.1016/j.ejca.2012.09.017
[18]	Thigpen JT, Brady MF, Alvarez RD, et al. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose-response study by the Gynecologic Oncology Group[J]. J Clin Oncol, 1999, 17(6):1736-1744. doi: 10.1200/JCO.1999.17.6.1736. doi: 10.1200/JCO.1999.17.6.1736 pmid: 10561210
[19]	Moore K, Brewer MA. Endometrial Cancer: Is This a New Disease?[J]. Am Soc Clin Oncol Educ Book, 2017, 37:435-442. doi: 10.1200/EDBK_175666. doi: 10.1200/EDBK_175666
[20]	Lee TY, Martinez-Outschoorn UE, Schilder RJ, et al. Metformin as a Therapeutic Target in Endometrial Cancers[J]. Front Oncol, 2018, 8:341. doi: 10.3389/fonc.2018.00341. doi: 10.3389/fonc.2018.00341
[21]	Yang B, Xie L, Zhang H, et al. Insulin resistance and overweight prolonged fertility-sparing treatment duration in endometrial atypical hyperplasia patients[J]. J Gynecol Oncol, 2018, 29(3):e35. doi: 10.3802/jgo.2018.29.e35. doi: 10.3802/jgo.2018.29.e35
[22]	中国研究型医院学会妇产科专业委员会. 早期子宫内膜癌保留生育功能治疗专家共识[J]. 临床医学研究与实践, 2019, 4(23):3. doi: 10.13390/j.issn.1672-1861.2019.04.025. doi: 10.13390/j.issn.1672-1861.2019.04.025
[23]	柳晓肃, 郭红燕, 宋雪凌, 等. 早期高分化子宫内膜癌及子宫内膜不典型增生患者保留生育功能治疗的结局分析[J]. 实用妇产科杂志, 2020, 36(9):685-689.
[24]	Chae SH, Shim SH, Lee SJ, et al. Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer[J]. Int J Gynecol Cancer, 2019, 29(1):77-85. doi: 10.1136/ijgc-2018-000036. doi: 10.1136/ijgc-2018-000036
[25]	Yamagami W, Susumu N, Makabe T, et al. Is repeated high-dose medroxyprogesterone acetate (MPA) therapy permissible for patients with early stage endometrial cancer or atypical endometrial hyperplasia who desire preserving fertility?[J]. J Gynecol Oncol, 2018, 29(2):e21. doi: 10.3802/jgo.2018.29.e21. doi: 10.3802/jgo.2018.29.e21