Background: Endometrial cancer (EC) is a common malignancy found among women. It is ranked as the 6th most common cancer among women and the 15th most common cancer globally. Increasing prevalence of several factors like obesity and other metabolic disorders have caused a growing trend of prevalence of endometrial cancer. The standard approach of treatment with excellent prognosis is total hysterectomy with bilateral salpingo-oophorectomy (TH/BSO). However, due to its drawback of complete infertility, newer approaches of fertility-sparing approaches are emerging to combat this challenge. Clinicians must choose the most suitable candidates for fertility-sparing surgery (FSS) using the present existing conventional criteria with regard to the patient’s age, tumor characteristics, and fertility goals. The limitations using the conventional criteria can be eliminated by refining the criteria with molecular prognostic factors to ease the candidate selection process for FSS. Methods: Relevant literature regarding molecular subtypes, hormone therapy sensitivity, clinical assessment, and guidelines pertaining to fertility preservation in EC were retrieved from several electronic databases and articles addressing the role of molecular profiling in predicting patient response, guiding patient selection, and/or informing the development of therapies for fertility preservation in early-stage EC, particularly in women of reproductive age were included. Primary focus was on areas of consensus, emerging trends, and evidence gaps that warrant further investigation. This review will assess the integration of molecular prognostic factors to refine the patient selection criteria and guide FSS in early-stage EC. We will present existing clinical criteria, ongoing clinical trials, limitations, and the advantages of integrating molecular data on patient selection, treatment safety, and fertility outcomes. Results: Four distinct molecular subtypes have been classified which includes POLE-mut, MMR-d, p53-abn and NSMP. POLE-mut subtype had excellent prognosis with >95% patients achieving complete remission with <2% recurrence rate followed by MMRd and NSMP with intermediate prognosis and lastly p53-abn with poor prognosis of 60–70% achieving complete remission and 30–40% having recurrence. The data highlights the clinical value of molecular classification in selecting appropriate candidates for fertility sparing surgery (FSS). Conclusions: There is a lack of integration of molecular subtypes for clinicians to choose candidates for FSS and this gap should be addressed. Further research must be performed to follow personalized medicine to refine their treatment plan.
背景：子宫内膜癌（EC）是女性常见的恶性肿瘤，在女性癌症中排名第六，在全球癌症中排名第十五。肥胖及其他代谢紊乱等因素的日益普遍导致子宫内膜癌的发病率呈上升趋势。标准治疗方法为全子宫切除加双侧输卵管卵巢切除术（TH/BSO），预后良好。然而，由于该方法会导致完全丧失生育能力，为应对这一挑战，保留生育功能的新方法正在兴起。临床医生必须根据患者年龄、肿瘤特征和生育目标，利用现有的常规标准选择最适合进行保留生育功能手术（FSS）的患者。通过结合分子预后因素优化标准，可以消除常规标准的局限性，从而简化FSS患者的选择过程。 方法：从多个电子数据库及相关文献中检索了关于EC分子亚型、激素治疗敏感性、临床评估以及生育力保留指南的资料，重点关注分子谱分析在预测患者反应、指导患者选择和/或为早期EC（尤其是育龄女性）生育力保留治疗提供依据方面的作用。主要关注共识领域、新兴趋势以及需要进一步研究的证据空白。本综述将评估分子预后因素在优化早期EC患者选择标准和指导FSS中的应用，并介绍现有临床标准、正在进行的临床试验、局限性，以及整合分子数据对患者选择、治疗安全性和生育结局的优势。 结果：目前已分类出四种不同的分子亚型，包括POLE突变型、错配修复缺陷型、p53异常型和非特异性分子谱型。POLE突变型预后极佳，超过95%的患者达到完全缓解，复发率低于2%；错配修复缺陷型和非特异性分子谱型预后中等；p53异常型预后较差，60-70%的患者达到完全缓解，30-40%的患者出现复发。这些数据突显了分子分型在选择适合进行保留生育功能手术（FSS）患者中的临床价值。 结论：目前临床医生在选择FSS患者时缺乏分子亚型的整合应用，这一空白亟待填补。未来需进一步研究，推动个体化医疗以优化治疗方案。
肿瘤(癌症)患者之家