低危險子宮內膜癌復發的檢視

The role of adjuvant therapy for early low-risk endometrial cancer

早期低風險的子宮內膜癌經手術治療後的結果良好，5年存活率達90%，然一旦復發，便沒有很好的方式來治療，預後差。因此根據臨床病理上危險因子如年齡、期別、組織學分類、腫瘤細胞的分化和淋巴管的轉移等，予以輔助治療，避免病灶復發就更顯重要。2013年癌症基因圖譜（TCGA）將子宮內膜癌的分子醫學分為POLE突變、微衛星不穩定型、低複製數目和高複製數目等4類，與預後可能有關。最近，根據這些分子研究，可以作為子宮內膜癌專屬的輔助治療，對預後良好者（POLE突變）不需追加任何輔助治療，但對預後欠佳者（p53 abn，即高複製數目）則需考慮加強輔助治療。透過各種子宮內膜癌分子醫學分類和臨床病理學研究，冀望將來能更了解如何給予適合的輔助治療。

The early, low risk endometrial cancer is generally received surgical treatment with an excellent prognosis. Although 5-year survival for this patients is about 90%, when they do recur, they have an especially poor prognosis and few treatment options. Therefore, adjuvant therapy recommendations for endometrial cancer were based on the risk factor of recurrence using clinicopathologic factor such as age, stage, histologic subtype, tumor grade and lymphovascular space invasion. In 2013, The Cancer Genome Atlas (TCGA) defined four distinct endometrial cancer subgroups (POLE mutated, microsatellite instability, low copy numbers, and high copy number) with possible prognostic value. Recently, it may be used to personalize adjuvant treatment after the molecular analysis, that treatment de-escalation is considered in endometrial cancer with favorable molecular factor (e.g. POLEmut endometrial cancer) and intensified treatment are considered in the presence of unfavorable factors (e.g. p53abn endometrial cancer). In future studies, incorporated of the molecular characteristics into the current clinicopathological classification may shift the adjuvant treatment recommendations.