(1) Background: Endometrial cancer (EC) is a common gynecological malignancy, often diagnosed at an early stage with a high overall survival rate. Surgical treatment is the primary approach, guided by pathological and molecular characteristics. Stage IVB EC, characterized by intra and/or extra-abdominal metastasis, presents a significant challenge with no clear consensus on optimal management. (2) Methods: A systematic literature review was conducted from January to May 2023, covering studies from 2000 to 2023. Eligible studies included retrospective case series, prospective trials, and randomized clinical trials. (3) Results: Of 116 studies identified, 21 were deemed relevant: 7 on primary surgery, 10 on neoadjuvant chemotherapy (NACT), and 4 on adjuvant treatment. Notably, the impact of residual tumor after primary surgery was a critical factor affecting survival. The use of NACT followed by interval debulking surgery showed promise, particularly in cases deemed unresectable. Adjuvant treatment, combining radiotherapy and chemotherapy, demonstrated improved survival but lacked consensus regarding its role. (4) Conclusions: Stage IVB EC poses a complex challenge with limited evidence to guide management. Optimal cytoreduction remains crucial, and NACT should be considered for unresectable cases. Multimodality adjuvant therapy may benefit patients, even with disease spread beyond the pelvis. Future advances in molecular classification and targeted therapies are expected to enhance treatment strategies.
（1）背景：子宫内膜癌（EC）是一种常见的妇科恶性肿瘤，通常在早期诊断，总体生存率较高。手术治疗是主要方法，依据病理和分子特征进行指导。IVB期EC以腹腔内和/或腹腔外转移为特征，治疗面临重大挑战，目前尚无明确的最佳管理共识。（2）方法：于2023年1月至5月进行了系统性文献综述，涵盖2000年至2023年的研究。符合条件的研究包括回顾性病例系列、前瞻性试验和随机临床试验。（3）结果：在确定的116项研究中，21项被认为相关：7项关于初次手术，10项关于新辅助化疗（NACT），4项关于辅助治疗。值得注意的是，初次手术后残留肿瘤的影响是影响生存的关键因素。使用NACT后进行间歇性肿瘤细胞减灭术显示出前景，特别是在被认为无法切除的病例中。辅助治疗结合放疗和化疗，显示出改善生存的效果，但其作用尚未达成共识。（4）结论：IVB期EC带来了复杂的挑战，指导治疗的证据有限。最佳肿瘤细胞减灭术仍然至关重要，对于无法切除的病例应考虑NACT。多模式辅助治疗可能使患者受益，即使疾病已扩散至盆腔以外。未来分子分类和靶向治疗的进展有望提升治疗策略。
Optimal Management for Stage IVB Endometrial Cancer: A Systematic Review
肿瘤(癌症)患者之家