从输卵管到卵巢癌:了解浆液性输卵管上皮内癌病变的评估和处理。

IF 4.7 2区 医学 Q2 ONCOLOGY
Vinita Popat, Ernest Han
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引用次数: 0

摘要

意见声明:卵巢癌,特别是高级别浆液性癌(HGSC),仍然是妇科肿瘤死亡的主要原因。新兴研究发现浆液性输卵管上皮内癌(STIC)是许多HGSC病例的前驱病变,突出了其在卵巢癌发病和预防中的作用。STIC的管理是具有挑战性的,因为只有有限的数据可用于指导临床决策。对于中等风险的妇女,机会性输卵管切除术越来越多地被用于常规手术,如子宫切除术或剖宫产术。这种干预在降低卵巢癌发病率的同时保持安全性和可行性方面显示出显著的潜力。对于高危人群,特别是BRCA突变携带者,降低风险的输卵管卵巢切除术(RRSO)仍然是金标准。RRSO可显著降低卵巢癌的风险,但目前正在研究其他方法,如单独输卵管切除术或根治性纤维切除术,以保护年轻患者的卵巢功能。为了提高STIC的检测,当患者接受降低风险的手术以预防卵巢癌时,推荐使用SEE-FIM病理学方案,但诸如诊断的可变性和有限的数据等挑战仍然存在。当偶然发现STIC时,治疗方法根据危险因素和病变特征而有所不同。当确诊为STIC时,遗传咨询和检测是必要的,因为遗传易感性可以指导进一步的治疗。对于伴有微创癌的STIC患者,建议进行手术治疗,但在文献中对STIC的常规手术治疗并没有明确的定义。当发现STIC且附件结构尚未切除时,通常建议双侧卵巢切除术。不建议化疗治疗STIC。当确诊为STIC时,建议进行监测,但没有关于监测频率和类型的固定指导方针。未来的方向包括完善分子谱来预测病情进展,并进行随机研究以建立循证指南。多学科合作对于优化预防和治疗至关重要,最终可降低HGSC发病率并改善患者预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
From Fallopian Tube to Ovarian Cancer: Understanding the Evaluation and Management of Serous Tubal Intraepithelial Carcinoma Lesions.

Opinion statement: Ovarian cancer, particularly high-grade serous carcinoma (HGSC), remains a leading cause of mortality in gynecologic oncology. Emerging research identifies serous tubal intraepithelial carcinoma (STIC) as a precursor lesion in many HGSC cases, highlighting its role in ovarian cancer pathogenesis and prevention. Management of STIC is challenging, as there is only limited data available to guide clinical decision-making. For average-risk women, opportunistic salpingectomy is increasingly being adopted during routine procedures such as hysterectomy or cesarean section. This intervention has demonstrated significant potential in reducing ovarian cancer incidence while maintaining safety and feasibility. For high-risk individuals, particularly BRCA mutation carriers, risk-reducing salpingo-oophorectomy (RRSO) remains the gold standard. RRSO significantly lowers ovarian cancer risk, though alternative approaches like salpingectomy alone or radical fimbriectomy are under investigation to preserve ovarian function in younger patients. To improve STIC detection, SEE-FIM pathology protocol is recommended when patients are undergoing risk-reducing surgery to prevent ovarian cancer, but challenges such as diagnostic variability and limited data persist. When STIC is detected incidentally, management varies based on risk factors and lesion characteristics. Genetic counseling and testing are essential when STIC is identified, as hereditary predisposition may guide further management. Surgical management is advised for cases of STIC with microinvasive carcinoma, but routine use of surgical management for STIC is not clearly defined in the literature. Bilateral oophorectomy is generally recommended when STIC is identified, and adnexal structures have not yet been removed. Chemotherapy is not recommended for treatment of STIC. Surveillance is suggested when STIC has been diagnosed, but there are no set guidelines as to the frequency and type of monitoring. Future directions include refining molecular profiling to predict progression and conducting randomized studies to establish evidence-based guidelines. Multidisciplinary collaboration is essential to optimize prevention and treatment, ultimately reducing HGSC incidence and improving patient outcomes.

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来源期刊
CiteScore
7.10
自引率
0.00%
发文量
113
审稿时长
>12 weeks
期刊介绍: This journal aims to review the most important, recently published treatment option advances in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to facilitate worldwide approaches to cancer treatment. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as endocrine tumors, lymphomas, neuro-oncology, and cancers of the breast, head and neck, lung, skin, gastrointestinal tract, and genitourinary region. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. We also provide commentaries from well-known oncologists, and an international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research.
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