子宫内膜癌诊断治疗的进展

子宫内膜癌的发生率近年来有上升趋势,矢岛聪报道在日本近10年增加二倍。对该病的诊治方面有了一定的进展,本文就有关问题概述如下。一、子宫内膜癌与雌激素的关系: 1.在生理情况下雌激素对宫内膜的影响受到孕激素的拮抗。当无排卵、无黄体形成时,则雌激素不遭拮抗,从而长期刺激宫内膜而导     

子宫内膜癌激素治疗进展

子宫内膜癌为女性生殖系统常见的恶性肿瘤之一,且近年的发病率呈上升趋势.目前,临床治疗以手术治疗为主,辅以激素治疗、化疗、放疗等.早期子宫内膜癌以手术治疗为主,治愈率达70%,晚期复发或伴有高危因素的子宫内膜癌以激素及化疗等姑息治疗为主.近年来,由于40岁以下患者逐年增加,其中年轻有生育要求的患者要求保留子宫.因此,激素治疗越来越受到更多的关注和研究,临床应用也取得较大进展.     

子宫内膜癌治疗药物的研究进展

药物治疗是子宫内膜癌治疗的重要组成部分,常用药物包括激素治疗药物（孕激素、抗雌激素药物、促性腺激素释放激素激动剂）、化疗药物（紫杉醇、铂类、蒽环类）和靶向药物（表皮生长因子受体拮抗剂、哺乳动物雷帕霉素靶蛋白抑制剂等）。随着研究的深入,越来越多的抗子宫内膜癌新靶点被发现,包括血管内皮生长因子（VEGF）、聚腺苷二磷酸核糖聚合酶（PARP）、程序性死亡受体1（PD-1）和PD-1配体（PD-L1）,中药和天然单体化合物也是目前的研究热点。对子宫内膜癌治疗药物的作用机制及研究进展进行综述,以期对该病治疗及新药研发有所裨益。     

子宫内膜癌临床治疗分析

目的探讨子宫内膜癌的临床特点、手术病理分期以及及预后影响因素。方法对64例子宫内膜癌患者的临床症状、治疗方法、临床分期、手术病理分期及预后回顾性分析。结果 64例患者存活5年以上者49例,死亡15例,总生存率为76.6%。肌层浸润程度、手术病理分期、术后辅助治疗对预后有明显影。结论对子宫内膜癌患者术前进行多因素综合评估,以提高临床分期的准确性,正确地选择术式及术后治疗,有效提高治疗效果及术后生存质量。     

子宫内膜癌的治疗与诊断

子宫内膜癌（endometrial carcinoma）,又称为子宫体癌（carcinoma of uterine corpus）,是一种常见的妇科恶性肿瘤,其发病率逐渐升高,发病率仅次于宫颈癌,在部分国家已经超过宫颈癌,成为最常见的妇科生殖道恶性肿瘤。     

子宫内膜癌的内分泌治疗

目的探讨子宫内膜癌的内分泌治疗效果。方法本次医学研究选取我院2008年1月至2012年12月之间收治的200例子宫内膜癌患者为观察对象,将患者随机分为对照组和实验组,两组患者均接受综合治疗,实验组在此基触上接受内分泌治疗,对比两组患者临床疗效。结果两组观察对象无瘤生存率、复发转移率对比无明显统计学差异（P〉0．05）。实验组内部不同内分泌治疗时间患者病死率、复发转移率对比具有明显的统计学差异（P〈0．05）。结论由本次临床研究结果可知,子宫内膜癌患者在常规综合治疗的基础上,接受内分泌治疗,具有较为满意的临床疗效,能够显著降低患者的病死率和复发转移率,因而,豳床应用价值较高。     

影响子宫内膜癌预后因素探讨

子宫内膜癌是女性生殖道常见恶性肿瘤，占女性生殖道恶性肿瘤的20％～30％，近年来发病率有上升趋势，影响子宫内膜癌预后的因素很多，本文对42例内膜癌预后的影响因素加以分析探讨。材料和方法材料来源于本院妇科1974～1991年内收治的42例内膜癌患者活检后手术标本，根据癌灶大小取材1～7块及淋巴结，经常规制片，部分作了网纤染色、PAS染色，在光镜下观察诊断、借鉴R0bby（1982）分类和WHO（1975）的三级分级法结合肿瘤细胞分化程度和浸润肌层深度进行组织学分级，并作术后随访观察与预后的关系。讨论一、患者年龄对预后的影响子宫内膜…     

子宫内膜癌激素治疗的临床观察

<正>子宫内膜癌是较常见的妇科恶性肿癌,近年发病率有上升趋势,随着对疾病认识的不断提高,子宫内膜癌的诊断和治疗模式也出现了变化,除了以手术为主,并进行精确的手术——病理分期外,还需辅助激素化疗和放疗等治疗,孕激素因毒性低,可转化内膜而常用     

子宫内膜癌的内分泌治疗研究进展

随着生活质量的提高与生活压力的增加,子宫内膜癌的发病率逐年升高。手术治疗是子宫内膜癌最主要的治疗手段,内分泌治疗作为辅助治疗方法之一也发挥着重要作用,但目前其用药方案与治疗机制仍待进一步探究。因此,本文综合国内外文献,对子宫内膜癌的内分泌治疗药物种类及作用机制、应用范围、疗效检测指标及未来发展方向进行阐述。     

子宫内膜癌手术治疗的护理

我院２０００年６月～２００１年９月手术治疗子宫内膜癌２２例 ,配合放疗、化疗 ,疗效显著。笔者收集２２例子宫内膜癌患者手术治疗的资料 ,对有关临床护理总结如下 :１临床资料２２例子宫内膜癌患者中 ,年龄４０～７０岁 ,平均５４ .７岁。职业 :农民１０例 ,工人５例 ,干部２例 ,教师２例 ,无业人员３例。病理诊断 :子宫内膜腺癌１６例 ,腺鳞癌４例 ,透明细胞癌１例 ,乳头状浆液腺癌１例。麻醉方式 :３例为硬膜外麻醉 ,１９例为全麻。手术方式 :广泛子宫切除加盆腔淋巴结清扫１３例 ,次广泛子宫切除７例 ,全宫双附件切除２例。术后并发症…     

An update on the current pharmacotherapy for endometrial cancer

Introduction: Endometrial cancer (EC) is the most common gynecologic malignancy in the developed world and is increasing in incidence. While the mainstay of treatment for EC is surgery followed by chemotherapy and/or radiation therapy, the available pharmacotherapies are rapidly and constantly evolving. Understanding these new therapies is an important part of the research and clinical care of women with EC. A review of available literature from MEDLINE (1879–2015) was conducted for the historic treatments and current therapies available for endometrial tumors.

Areas covered: This article reviews the current conventional therapies and discusses novel therapeutic agents, some of which are available to clinicians while others are currently being investigated in the preclinical setting.

Expert opinion: Genomic and immunohistochemical characterization of endometrial cancer may soon be the best approach for the identification of aggressive forms of tumor. Targeted therapies will soon be standard in the management of endometrial cancer.     

子宫内膜癌靶向药物治疗研究进展

子宫内膜癌的化疗耐药性问题显著,迫切需要新的治疗方案。随着对肿瘤发病机制和信号传导通路的深入研究,以及表观遗传修饰作用机制的阐明,靶向药物研究为子宫内膜癌的治疗提供了新的方法和手段。本文综述了表皮生长因子受体拮抗剂、血管内皮生长因子抑制剂、PI3K/Akt/mTOR通路抑制剂、PD-1/PD-L1抑制剂和表观遗传修饰抑制剂等靶向药物在子宫内膜癌治疗领域的研究进展,为临床用药提供新思路。     

Systemic therapy for the treatment of endometrial cancer

ABSTRACT

Introduction: Endometrial cancer (EC) is one of the most frequent gynecological cancers worldwide. The gold standard treatment of EC is most certainly surgery and may very well be the only therapy in the early stages of disease. To improve outcomes in non-early EC, adjuvant therapy is often employed but this is not standardized. Adjuvant options can include radiotherapy, chemotherapy or a combination of both. Adjuvant chemotherapy could be indicated in high-risk stage I and II or advanced stage EC. Several clinical trials are ongoing in an attempt to define the optimal adjuvant treatment. Furthermore, chemotherapy is the front-line therapy in advanced unresectable, metastatic or recurrent endometrial cancer.

Areas covered: Herein, the authors review the first-line chemotherapy for the treatment of endometrial cancer and provide their expert perspectives on these therapies.

Expert opinion: Chemotherapy is fundamental in advanced/recurrent EC. Further evidence is needed to characterize the role of adjuvant chemotherapy. Future studies should consider genomic and molecular heterogeneities to identify even more efficient tailored therapies.     

孕激素在子宫内膜癌前期病变和子宫内膜癌中的应用

子宫内膜癌是女性生殖道最常见的恶性肿瘤,大部分内膜癌前期病变及内膜癌可被早期诊断,且运用孕激素治疗能达到良好的效果。本文阐述孕激素的作用机制及在内膜癌前期病变及内膜癌中的治疗效果。     

Pharmacotherapy of endometrial cancer

Background: Endometrial cancer is the seventh most common malignancy among women worldwide. Despite most cases being diagnosed at an early stage, the death rate has increased steadily over the past 20 years. The lack of an effective, standardized adjuvant treatment for women at a high risk of recurrence has contributed to these disappointing results. Objectives: The goal of this review was to assess the role of hormonal and cytotoxic therapies in the adjuvant treatment of endometrial cancer. Once defined, an evidence-based management algorithm for this neoplasm was proposed. Methods: A thorough literature search was undertaken using the Cochrane and Pubmed databases. Systematic reviews, meta-analyses, and randomized controlled trials were first collected and critically analyzed. Other study types were secondarily considered when pertinent. Conclusions: The choice of the adjuvant therapy in early-stage endometrial cancer must be a patient-specific decision. Preliminary data suggest a role for chemotherapy in high-risk subgroups. However, further research is necessary to confirm this. To date, hormonal therapy has not been widely used in the management of early-stage disease, other than for conservative treatment in a fertility-sparing setting. Both hormonal and chemotherapy represent valuable therapeutic tools for the management of patients affected by advanced disease.     

Novel genetic targets in endometrial cancer

Worldwide, ～ 74,000 women die from endometrial cancer each year. Understanding the somatic genomic alterations that drive endometrial tumorigenesis may provide new opportunities to identify targeted therapies for specific subsets of patients. Since 2012, the use of next-generation sequencing to decode the mutational landscape of endometrial tumors has not only confirmed prior knowledge of established genetic targets for serous and endometrioid endometrial carcinomas (ECs), but has also uncovered novel significantly mutated genes, referred to herein as novel genetic targets, which represent candidate cancer genes in these tumors. This editorial summarizes the novel genetic targets that have been identified in serous and endometrioid ECs, according to their unifying functional characteristics. An expert opinion section comments on remaining knowledge gaps that will undoubtedly be filled in future genomic studies of endometrial cancer.     

Novel strategies for systemic treatment of endometrial cancer

The median survival of women with advanced or recurrent endometrial cancer is less than one year. Of the women with early stage endometrial cancer and poor prognostic factors like high grade or deep myometrial invasion, 40% will recur. Over the last decade, incredible strides have been taken in evaluating systemic therapy for this disease, however, survival rates remain poor. Progestin therapy offers a 10 - 20% response rate and survival of less than one year. Progestins are most effective in women with well-differentiated tumours and long disease-free interval. There is no role for adjuvant progestin therapy in early stage disease. Single-agent chemotherapy with most activity include ifosfamide, cisplatin/carboplatin, doxorubicin and paclitaxel. Combination chemotherapy provides a response rate of 40 - 60%, however, median survival is still less than a year. New areas of research include the identification and evaluation of new active endocrine therapies (i.e., LY-353381.HCl and letrozole), chemotherapeutics (i.e., paclitaxel), evaluating chemotherapeutic agents in combination (i.e., paclitaxel, doxorubicin and platinum), in addition to radiation or instead of radiation. New avenues under development involve the specific molecules and pathways responsible for the initiation and growth of endometrial carcinoma (i.e., Herceptin?). Exciting developments in the understanding of the molecules involved in tumour development and metastasis will allow the development of specific and selective inhibitors.     

Emerging drugs for endometrial cancer

Introduction: From the dualistic classification that divides endometrial cancer (EC) into two types with distinct underlying molecular profiling, histopathology and clinical behavior, arises a deeper understanding of the carcinogenesis pathways. EC treatment comprises different and multimodal therapeutic approaches, such as chemotherapy, radiation therapy or combinations of novel drugs; however, few of these regimens have truly improved progression-free or survival rates in advanced and metastatic settings.

Areas covered: We reviewed the main molecular pathways involved in EC carcinogenesis through a wide literature search of novel compounds that alone or in combination with traditional drugs have been investigated or are currently under investigation in randomized clinical trials.

Expert opinion: The molecular therapies mainly discussed in this review are potential therapeutic candidates for more effective and specific treatments. In the genomic era, a deeper knowledge about molecular characteristics of cancer provides the hope for the development of better therapeutic approaches. Targeting both genetic and epigenetic alterations, attacking tumor cells using cell-surface markers overexpressed in tumor tissue, reactivating antitumor immune responses and identifying predictive biomarkers represent the emerging strategies and the major challenges.     

Esorubicin in advanced endometrial cancer: an ineffective and potentially toxic therapy

Summary The Southwest Oncology Group conducted a phase II study of esorubicin treatment in patients with advanced endometrial cancer who had received no prior chemotherapy. Twenty of 31 patients were fully evaluable for response and toxicity. There were no clinical responses to treatment and 60% (12/20) of the patients developed severe or life threatening leukopenia on therapy. One evaluable patient was removed from study after a cumulative dose of 150 mg/M² due to a reduction in left ventricular ejection fraction on MUGA scan and another developed congestive heart failure several months after discontinuation of treatment. Esorubicin has significant toxicity and limited clinical activity in patients with advanced endometrial cancer. Address for offprints Southwest Oncology Group (SWOG-8408), Operations Office, 5430 Fredericksburg Road, Suite #618, San Antonio, TX 78229-6197, USA