曹梅　丘瑾　童晓文

[摘要] 子宫内膜癌是妇科常见的恶性肿瘤之一，在疾病的早期阶段可用手术方式治愈，但对于有复发倾向或组织学类型较差的处于中晚期阶段的患者，常联合辅助疗法进行治疗。然而在对于辅助疗法的应用时间及应用方式上，仍存在一些争议，主要表现在：①对于处于早中期阶段的子宫内膜癌患者，如何既能最大限度地减少药物毒副作用对患者的影响，又保证最佳的治疗效果；②而对于中晚期阶段的类型，如何选择最佳治疗策略以期获得最佳疗效，提高患者总的生存率及生活质量。此外，一些子宫内膜癌特异的基因和分子蛋白的发现，进一步完善了目前的疾病危险预测模型，同时为子宫内膜癌的个体化及靶向治疗提供了良好的基础。本文通过阅读近年来国内外相关领域的文献，对不同阶段子宫内膜癌辅助治疗的研究进展进行综述。

[关键词] 辅助疗法；子宫内膜癌；危险分层；个体化治疗

[中图分类号] R737.33 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0165-05

[Abstract] Endometrial cancer is a common gynecologic malignancy typically diagnosed at early stage and cured with surgery alone. But， for patients sustained with locally advanced endometrial cancer or the aggressive variant histologic types that have a great risk of recurrence， the adjuvant therapy has played a great role in the therapeutic routine. However， controversies remain regarding the recommended therapeutic time and strategy for women with different stages of endometrial cancer. First， how to minimize the side effects of adjuvant therapy without compromising the therapeutic efficacy for the patients in early stage of endometrial cancer. Second， for the patients with locally advanced endometrial cancer， the most important is to make the optimal choice of therapeutic strategy to receive a better treatment result， which means the improvement of overall survival rate and quality of life. What's more， with the research progress of molecular biology， some endometrial cancer specific genes and molecular proteins have been found， which may aid refine the current risk prediction model and permit personalized approaches and targeted therapy for women with endometrial cancer. This paper summarizes the research progress of adjuvant therapy related studies in the treatment of each period of endometrial cancer.

[Key words] Adjuvant therapy； Endometrial cancer； Risk stratification； Individual therapy

子宫内膜癌（endometrial cancer，EC）是女性生殖系统常见的恶性肿瘤，近年来，在亚洲发展中国家的发病率呈上升趋势，仅次于宫颈癌。目前，根据EC的分子生物学特点和典型的临床表现，主要分为两型。1型EC多表达雌激素和孕酮受体，通过促进激酶变异和磷酸酶的缺失改变PT3K/AKT信号通路，且出现多卫星病灶（multisatellite）不稳定和β-catenin变异[1]。这是EC最常见的类型，占整个子宫内膜癌发病率的80%，与雌激素水平密切相关，常发生于绝经后的女性，通常可在早期阶段即被发现，但预后相对较好。……