Geburtshilfe Frauenheilkd 2023; 83(08): 919-962
DOI: 10.1055/a-2066-2051
GebFra Science
Guideline/Leitlinie

Endometriumkarzinom. Leitlinie der DGGG, DKG und DKH (S3-Level, AWMF-Register-Nummer 032/034-OL, September 2022). Teil 1 mit Empfehlungen zu Epidemiologie, Früherkennung, Diagnostik, hereditären Faktoren des Endometriumkarzinoms, geriatrischem Assessment und Versorgungsstrukturen

Artikel in mehreren Sprachen: English | deutsch
Günter Emons
1   Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
,
Eric Steiner
2   Frauenklinik GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
,
Dirk Vordermark
3   Universität Halle (Saale), Radiotherapie, Halle (Saale), Germany
,
Christoph Uleer
4   Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Germany
,
Kerstin Paradies
5   Konferenz onkologischer Kranken- und Kinderkrankenpfleger (KOK), Hamburg, Germany
,
Clemens Tempfer
6   Frauenklinik der Ruhr-Universität Bochum, Bochum/Herne, Germany
,
Stefan Aretz
7   Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Bonn, Germany
,
Wolfgang Cremer
8   Praxis für Frauenheilkunde Hamburg, Hamburg, Germany
,
Volker Hanf
9   Frauenklinik Nathanstift – Klinikum Fürth, Fürth, Germany
,
Peter Mallmann
10   Uniklinik Köln, Frauenheilkunde, Köln, Germany
,
Olaf Ortmann
11   Universität Regensburg, Fakultät für Medizin, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Germany
,
Thomas Römer
12   Evangelisches Klinikum Köln Weyertal, Gynäkologie Köln, Köln, Germany
,
Rita K. Schmutzler
13   Universitätsklinikum Köln, Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
,
Lars-Christian Horn
14   Universitätsklinikum Leipzig, Institut für Pathologie, Leipzig, Germany
,
Stefan Kommoss
15   Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
,
Sigurd Lax
16   Institut für Pathologie, LKH Graz Süd-West, Graz, Austria
,
Elisa Schmoeckel
17   Pathologisches Institut der LMU München, München, Germany
,
Theresa Mokry
18   Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg, Germany
,
Dieter Grab
19   Universitätsklinikum Ulm, Frauenheilkunde und Geburtshilfe, Ulm, Germany
,
Michael Reinhardt
20   Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
,
Verena Steinke-Lange
21   MGZ – Medizinisch Genetisches Zentrum München, München, Germany
22   Medizinische Klinik und Poliklinik IV, LMU München, München, Germany
,
Sara Y. Brucker
15   Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
,
Ludwig Kiesel
23   Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
,
Ralf Witteler
23   Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
,
Markus C. Fleisch
24   Helios, Universitätsklinikum Wuppertal, Landesfrauenklinik, Wuppertal, Germany
,
Heinrich Prömpeler †,
Michael Friedrich
26   Helios Klinikum Krefeld, Klinik für Frauenheilkunde und Geburtshilfe, Krefeld, Germany
,
Stefan Höcht
27   XCare, Praxis für Strahlentherapie Saarlouis, Saarlouis, Germany
,
Werner Lichtenegger
28   Universitätsmedizin Berlin, Frauenklinik Charité, Campus Virchow-Klinikum, Berlin, Germany
,
Michael Mueller
29   Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
,
Ingo Runnebaum
30   Universitätsklinikum Jena, Frauenklinik, Jena, Germany
,
Petra Feyer
31   Vivantes Klinikum Neukölln, Klinik für Strahlentherapie und Radioonkologie, Berlin, Germany
,
Volker Hagen
32   Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Dortmund, Germany
,
Ingolf Juhasz-Böss
33   Universitätsklinikum Freiburg, Gynäkologie Freiburg, Freiburg, Germany
,
Anne Letsch
34   Universitätsklinikum Schleswig Holstein, Campus Kiel, Innere Medizin, Kiel, Germany
,
Peter Niehoff
35   Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
,
Alain Gustave Zeimet
36   Medizinische Universität Innsbruck, Universitätsklinik für Gynäkologie und Geburtshilfe, Innsbruck, Austria
,
Marco Johannes Battista
37   Universitätsmedizin Mainz, Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
,
Edgar Petru
38   Med. Univ. Graz, Frauenheilkunde, Graz, Austria
,
Simone Widhalm
39   Semi-Colon, Mönchengladbach, Germany
,
Birgitt van Oorschot
40   Universitätsklinikum Würzburg, Interdisziplinäres Zentrum Palliativmedizin, Würzburg, Germany
,
Joan Elisabeth Panke
41   Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V. Essen, Essen, Germany
,
Joachim Weis
42   Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Tumorzentrum Freiburg – CCCF, Freiburg, Germany
,
Timm Dauelsberg
43   Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
,
Heidemarie Haase
44   Frauenselbsthilfe, Bonn, Germany
,
Matthias W. Beckmann
45   Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Germany
,
Sebastian Jud
46   Mutterhaus der Borromäerinnen, Trier, Germany
,
Edward Wight
47   Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
,
Franz-Josef Prott
48   Facharzt für Radiologie und Strahlentherapie, Wiesbaden, Wiesbaden, Germany
,
Oliver Micke
49   Franziskus Hospital Bielefeld, Klinik für Strahlentherapie und Radioonkologie, Bielefeld, Germany
,
Werner Bader
50   Klinikum Bielefeld Mitte, Zentrum für Frauenheilkunde, Bielefeld, Germany
,
Nicola Reents
39   Semi-Colon, Mönchengladbach, Germany
,
Ulla Henscher
51   Physio-Akademie, Hannover, Germany
,
Reina Tholen †,
Miriam Schallenberg
44   Frauenselbsthilfe, Bonn, Germany
,
Nils Rahner
53   Amedes Group Bonn, Bonn, Germany
,
Doris Mayr
54   LMU München, Pathologisches Institut, München, Germany
,
Michael Kreißl
55   Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Radiologie und Nuklearmedizin, Germany
,
Katja Lindel
56   Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
,
Alexander Mustea
57   Universitätsklinikum Bonn, Zentrum Gynäkologie und gynäkologische Onkologie, Bonn, Germany
,
Vratislav Strnad
58   Universitätsklinikum Erlangen, Brustzentrum Franken, Erlangen, Germany
,
Ute Goerling
59   Universitätsmedizin Berlin, Campus Charité Mitte, Charité Comprehensive Cancer Center, Berlin, Germany
,
Gerd J. Bauerschmitz
1   Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
,
Jan Langrehr
60   Martin-Luther-Krankenhaus, Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Berlin, Germany
,
Joseph Neulen
61   Uniklinik RWTH Aachen, Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Aachen, Germany
,
Uwe Andreas Ulrich
62   Martin-Luther-Krankenhaus, Johannesstift Diakonie, Gynäkologie, Berlin, Germany
,
Monika J. Nothacker
63   AWMF, AWMF-IMWi, Berlin, Germany
,
Susanne Blödt
63   AWMF, AWMF-IMWi, Berlin, Germany
,
Markus Follmann
64   Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
,
Thomas Langer
64   Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
,
Gregor Wenzel
64   Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
,
Sylvia Weber
1   Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
,
Saskia Erdogan
1   Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
› Institutsangaben

Zusammenfassung

Zusammenfassung Die im April 2018 erstmals publizierte S3-Leitlinie Endometriumkarzinom wurde von April 2020 bis Januar 2022 komplett geprüft und aktualisiert. Dies wurde von der Deutschen Krebshilfe im Rahmen des Leitlinienprogramms Onkologie gefördert und von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), der Arbeitsgemeinschaft Onkologische Gynäkologie (AGO) der Deutschen Krebsgesellschaft (DKG) und der Deutschen Krebshilfe (DKH) federführend koordiniert. Für das Update der Leitlinie wurde die systematisch recherchierte und bewertete Literatur von 2016 bis 2020 verwendet. Alle Statements, Empfehlungen und Hintergrundtexte wurde geprüft und entweder bestätigt oder modifiziert. Soweit erforderlich, wurden neue Statements und Empfehlungen hinzugenommen.

Ziel Durch eine evidenzbasierte risikoadaptierte Therapie können bei den Frauen mit Endometriumkarzinom mit geringem Risiko eine unnötige Radikalität bei der Operation und nicht sinnvolle adjuvante Strahlen- und/oder Chemotherapie vermieden werden. Für die Frauen mit einem Endometriumkarzinom mit hohem Rezidivrisiko definiert die Leitlinie die optimale operative Radikalität sowie die ggf. erforderliche Chemotherapie und/oder adjuvante Strahlentherapie. Dadurch sollen Überleben und Lebensqualität dieser Patientinnen verbessert werden. Die S3-Leitlinie zum Endometriumkarzinom und die auf ihr basierenden Qualitätsindikatoren sollen eine Grundlage für die Arbeit der zertifizierten gynäkologischen Krebszentren sein.

Methoden Die Leitlinie wurde 2018 gemäß den Anforderungen eines S3-Niveaus erarbeitet und 2022 aktualisiert. Dies umfasst zum einen die Adaptation der mittels des DELBI-Instruments gefundenen Quellleitlinien. Zum anderen Evidenzübersichten, die anhand der in systematischen Recherchen nach dem PICO-Schema in ausgewählten Literaturdatenbanken selektierten Literatur erstellt wurden. Mit der systematischen Literaturrecherche und -Bewertung war die Clinical Guidelines Service Group beauftragt. Diese Ergebnisse dienten den interdisziplinären Arbeitsgruppen als Basis für die Erarbeitung von Vorschlägen für Empfehlungen und Statements, die in strukturierten Online-Konsensuskonferenzen und/oder ergänzend im DELPHI-Verfahren modifiziert und konsentiert wurden.

Empfehlungen Der Teil 1 dieser Kurzversion der Leitlinie gibt Empfehlungen zu Epidemiologie, Früherkennung, Diagnostik und hereditären Faktoren: Die Epidemiologie des Endometriumkarzinoms und die Risikofaktoren für seine Entstehung werden dargestellt. Die Möglichkeiten der Früherkennung und die Methoden der Diagnostik werden behandelt. Es werden Empfehlungen zur Prävention, Diagnostik und Therapie von erblichen Formen des Endometriumkarzinoms dargelegt. Zudem werden das geriatrische Assessment berücksichtigt und die Versorgungsstrukturen aufgezeigt.



Publikationsverlauf

Eingereicht: 17. März 2023

Angenommen nach Revision: 22. Juni 2023

Artikel online veröffentlicht:
15. August 2023

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References/Literatur

  • 1 Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V.. Krebs in Deutschland 2015/2016. 2019. Zugriff am 25. Juli 2023 unter: https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs in Deutschland/kid2019krebs_in_deutschland_2019.pdf?_blob=publicationFile
  • 2 Tempfer CB, Hilal Z, Kern P. et al. Menopausal Hormone Therapy and Risk of Endometrial Cancer: A Systematic Review. Cancers (Basel) 2020; 12: 2195
  • 3 Lacey jr. JV, Brinton LA, Lubin JH. et al. Endometrial carcinoma risks among menopausal estrogen plus progestin and unopposed estrogen users in a cohort of postmenopausal women. Cancer Epidemiol Biomarkers Prev 2005; 14: 1724-1731
  • 4 Allen NE, Tsilidis KK, Key TJ. et al. Menopausal hormone therapy and risk of endometrial carcinoma among postmenopausal women in the European Prospective Investigation Into Cancer and Nutrition. Am J Epidemiol 2010; 172: 1394-1403
  • 5 Marjoribanks J, Farquhar C, Roberts H. et al. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2017; (01) CD004143
  • 6 Beral V, Bull D, Reeves G. Endometrial cancer and hormone-replacement therapy in the Million Women Study. Lancet 2005; 365: 1543-1551
  • 7 Nelson HD, Humphrey LL, Nygren P. et al. Postmenopausal hormone replacement therapy: scientific review. JAMA 2002; 288: 872-881
  • 8 Grady D, Gebretsadik T, Kerlikowske K. et al. Hormone replacement therapy and endometrial cancer risk: a meta-analysis (Structured abstract). Obstet Gynecol 1995; 85: 304-313
  • 9 Razavi P, Pike MC, Horn-Ross PL. et al. Long-term postmenopausal hormone therapy and endometrial cancer. Cancer Epidemiol Biomarkers Prev 2010; 19: 475-483
  • 10 Chlebowski RT, Anderson GL, Sarto GE. et al. Continuous Combined Estrogen Plus Progestin and Endometrial Cancer: The Womenʼs Health Initiative Randomized Trial. J Natl Cancer Inst 2015; 108: djv350
  • 11 Mørch LS, Kjaer SK, Keiding N. et al. The influence of hormone therapies on type I and II endometrial cancer: A nationwide cohort study. Int J Cancer 2016; 138: 1506-1515
  • 12 Fournier A, Dossus L, Mesrine S. et al. Risks of endometrial cancer associated with different hormone replacement therapies in the E3 N cohort, 1992–2008. Am J Epidemiol 2014; 180: 508-517
  • 13 Doherty JA, Cushing-Haugen KL, Saltzman BS. et al. Long-term use of postmenopausal estrogen and progestin hormone therapies and the risk of endometrial cancer. Am J Obstet Gynecol 2007; 197: 139.e1-139.e7
  • 14 Sjögren LL, Mørch LS, Løkkegaard E. Hormone replacement therapy and the risk of endometrial cancer: A systematic review. Maturitas 2016; 91: 25-35
  • 15 Emons G, Mustea A, Tempfer C. Tamoxifen and Endometrial Cancer: A Janus-Headed Drug. Cancers (Basel) 2020; 12: 2535
  • 16 Nelson HD, Smith ME, Griffin JC. et al. Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013; 158: 604-614
  • 17 Braithwaite RS, Chlebowski RT, Lau J. et al. Meta-analysis of vascular and neoplastic events associated with tamoxifen. J Gen Intern Med 2003; 18: 937-947
  • 18 Al-Mubarak M, Tibau A, Templeton AJ. et al. Extended adjuvant tamoxifen for early breast cancer: a meta-analysis. PLoS One 2014; 9: e88238
  • 19 DeMichele A, Troxel AB, Berlin JA. et al. Impact of raloxifene or tamoxifen use on endometrial cancer risk: a population-based case-control study. J Clin Oncol 2008; 26: 4151-4159
  • 20 Ignatov A, Ortmann O. Endocrine Risk Factors of Endometrial Cancer: Polycystic Ovary Syndrome, Oral Contraceptives, Infertility, Tamoxifen. Cancers (Basel) 2020; 12: 1766
  • 21 Collaborative Group on Epidemiological Studies on Endometrial Cancer. Endometrial cancer and oral contraceptives: an individual participant meta-analysis of 27 276 women with endometrial cancer from 36 epidemiological studies. Lancet Oncol 2015; 16: 1061-1070
  • 22 Gierisch JM, Coeytaux RR, Urrutia RP. et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev 2013; 22: 1931-1943
  • 23 Parazzini F, Pelucchi C, Talamini R. et al. Use of fertility drugs and risk of endometrial cancer in an Italian case-control study. Eur J Cancer Prev 2010; 19: 428-430
  • 24 Siristatidis C, Sergentanis TN, Kanavidis P. et al. Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer–a systematic review and meta-analysis. Hum Reprod Update 2013; 19: 105-123
  • 25 Skalkidou A, Sergentanis TN, Gialamas SP. et al. Risk of endometrial cancer in women treated with ovary-stimulating drugs for subfertility. Cochrane Database Syst Rev 2017; (03) CD010931
  • 26 Ettinger B, Kenemans P, Johnson SR. et al. Endometrial effects of tibolone in elderly, osteoporotic women. Obstet Gynecol 2008; 112: 653-659
  • 27 Dossus L, Allen N, Kaaks R. et al. Reproductive risk factors and endometrial cancer: the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2009; 127: 442-451
  • 28 Setiawan VW, Pike MC, Karageorgi S. et al. Age at last birth in relation to risk of endometrial cancer: pooled analysis in the epidemiology of endometrial cancer consortium. Am J Epidemiol 2012; 176: 269-278
  • 29 Karageorgi S, Hankinson SE, Kraft P. et al. Reproductive factors and postmenopausal hormone use in relation to endometrial cancer risk in the Nursesʼ Health Study cohort 1976–2004. Int J Cancer 2009; 126: 208-216
  • 30 Friberg E, Orsini N, Mantzoros CS. et al. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. Diabetologia 2007; 50: 1365-1374
  • 31 Barone BB, Yeh HC, Snyder CF. et al. Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA 2008; 300: 2754-2764
  • 32 Huang Y, Cai X, Qiu M. et al. Prediabetes and the risk of cancer: a meta-analysis. Diabetologia 2014; 57: 2261-2269
  • 33 Zhang ZH, Su PY, Hao JH. et al. The role of preexisting diabetes mellitus on incidence and mortality of endometrial cancer: a meta-analysis of prospective cohort studies. Int J Gynecol Cancer 2013; 23: 294-303
  • 34 Liao C, Zhang D, Mungo C. et al. Is diabetes mellitus associated with increased incidence and disease-specific mortality in endometrial cancer? A systematic review and meta-analysis of cohort studies. Gynecol Oncol 2014; 135: 163-171
  • 35 Luo J, Beresford S, Chen C. et al. Association between diabetes, diabetes treatment and risk of developing endometrial cancer. Br J Cancer 2014; 111: 1432-1439
  • 36 Gnagnarella P, Gandini S, La Vecchia C. et al. Glycemic index, glycemic load, and cancer risk: a meta-analysis. Am J Clin Nutr 2008; 87: 1793-1801
  • 37 Mulholland HG, Murray LJ, Cardwell CR. et al. Dietary glycaemic index, glycaemic load and endometrial and ovarian cancer risk: a systematic review and meta-analysis. Br J Cancer 2008; 99: 434-441
  • 38 Choi Y, Giovannucci E, Lee JE. Glycaemic index and glycaemic load in relation to risk of diabetes-related cancers: a meta-analysis. Br J Nutr 2012; 108: 1934-1947
  • 39 Nagle CM, Olsen CM, Ibiebele TI. et al. Glycemic index, glycemic load and endometrial cancer risk: results from the Australian National Endometrial Cancer study and an updated systematic review and meta-analysis. Eur J Nutr 2012; 52: 705-715
  • 40 Fearnley EJ, Marquart L, Spurdle AB. et al. Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: an Australian case-control study. Cancer Causes Control 2010; 21: 2303-2308
  • 41 Gottschau M, Kjaer SK, Jensen A. et al. Risk of cancer among women with polycystic ovary syndrome: a Danish cohort study. Gynecol Oncol 2014; 136: 99-103
  • 42 Chittenden BG, Fullerton G, Maheshwari A. et al. Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online 2009; 19: 398-405
  • 43 Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome. Hum Reprod 2012; 27: 1327-1331
  • 44 Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2014; 20: 748-758
  • 45 Crosbie EJ, Zwahlen M, Kitchener HC. et al. Body mass index, hormone replacement therapy, and endometrial cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2010; 19: 3119-3130
  • 46 Ward KK, Roncancio AM, Shah NR. et al. The risk of uterine malignancy is linearly associated with body mass index in a cohort of US women. Am J Obstet Gynecol 2013; 209: 579.e1-579.e5
  • 47 Renehan AG, Tyson M, Egger M. et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371: 569-578
  • 48 Dobbins M, Decorby K, Choi BC. The Association between Obesity and Cancer Risk: A Meta-Analysis of Observational Studies from 1985 to 2011. ISRN Prev Med 2013; 2013: 680536
  • 49 Bergstrom A, Pisani P, Tenet V. et al. Overweight as an avoidable cause of cancer in Europe. Int J Cancer 2001; 91: 421-430
  • 50 Reeves KW, Carter GC, Rodabough RJ. et al. Obesity in relation to endometrial cancer risk and disease characteristics in the Womenʼs Health Initiative. Gynecol Oncol 2011; 121: 376-382
  • 51 Dörk T, Hillemanns P, Tempfer C. et al. Genetic Susceptibility to Endometrial Cancer: Risk Factors and Clinical Management. Cancers (Basel) 2020; 12: 2407
  • 52 Ma X, Zhao LG, Sun JW. et al. Association between breastfeeding and risk of endometrial cancer: a meta-analysis of epidemiological studies. Eur J Cancer Prev 2018; 27: 144-151
  • 53 Crosbie EJ, Zwahlen M, Kitchener HC. et al. Body mass index, hormone replacement therapy, and endometrial cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2010; 19: 3119-3130
  • 54 Kohler LN, Garcia DO, Harris RB. et al. Adherence to Diet and Physical Activity Cancer Prevention Guidelines and Cancer Outcomes: A Systematic Review. Cancer Epidemiol Biomarkers Prev 2016; 25: 1018-1028
  • 55 Zhang X, Rhoades J, Caan BJ. et al. Intentional weight loss, weight cycling, and endometrial cancer risk: a systematic review and meta-analysis. Int J Gynecol Cancer 2019; 29: 1361-1371
  • 56 Keum N, Ju W, Lee DH. et al. Leisure-time physical activity and endometrial cancer risk: dose-response meta-analysis of epidemiological studies. Int J Cancer 2014; 135: 682-694
  • 57 Gierach GL, Chang SC, Brinton LA. et al. Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer 2009; 124: 2139-2147
  • 58 Moore SC, Gierach GL, Schatzkin A. et al. Physical activity, sedentary behaviours, and the prevention of endometrial cancer. Br J Cancer 2010; 103: 933-938
  • 59 Voskuil DW, Monninkhof EM, Elias SG. et al. Physical activity and endometrial cancer risk, a systematic review of current evidence. Cancer Epidemiol Biomarkers Prev 2007; 16: 639-648
  • 60 Schmid D, Leitzmann MF. Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst 2014; 106: dju098
  • 61 Soini T, Hurskainen R, Grenman S. et al. Cancer risk in women using the levonorgestrel-releasing intrauterine system in Finland. Obstet Gynecol 2014; 124: 292-299
  • 62 Felix AS, Gaudet MM, La Vecchia C. et al. Intrauterine devices and endometrial cancer risk: a pooled analysis of the Epidemiology of Endometrial Cancer Consortium. Int J Cancer 2014; 136: E410-E422
  • 63 Manchanda R, Saridogan E, Abdelraheim A. et al. Annual outpatient hysteroscopy and endometrial sampling (OHES) in HNPCC/Lynch syndrome (LS). Arch Gynecol Obstet 2012; 286: 1555-1562
  • 64 Helder-Woolderink JM, De Bock GH, Sijmons RH. et al. The additional value of endometrial sampling in the early detection of endometrial cancer in women with Lynch syndrome. Gynecol Oncol 2013; 131: 304-308
  • 65 Raatz H, Glinz D. Systematische Reviews und Bewertung der Qualität der Evidenz im Rahmen der S3-Leitlinie Endometriumkarzinom. 2015. Zugriff am 14. Juni 2023 unter: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Endometriumkarzinom/Evidenzbericht_Screening_CEB_Basel.pdf
  • 66 Fleming CA, Heneghan HM, OʼBrien D. et al. Meta-analysis of the cumulative risk of endometrial malignancy and systematic review of endometrial surveillance in extended tamoxifen therapy. Br J Surg 2018; 105: 1098-1106
  • 67 Saccardi C, Gizzo S, Patrelli TS. et al. Endometrial surveillance in tamoxifen users: role, timing and accuracy of hysteroscopic investigation: observational longitudinal cohort study. Endocr Relat Cancer 2013; 20: 455-462
  • 68 Gao WL, Zhang LP, Feng LM. Comparative study of transvaginal ultrasonographic and diagnostic hysteroscopic findings in postmenopausal breast cancer patients treated with tamoxifen. Chin Med J (Engl) 2011; 124: 2335-2339
  • 69 Bertelli G, Valenzano M, Costantini S. et al. Limited value of sonohysterography for endometrial screening in asymptomatic, postmenopausal patients treated with tamoxifen. Gynecol Oncol 2000; 78: 275-277
  • 70 Gerber B, Krause A, Muller H. et al. Effects of adjuvant tamoxifen on the endometrium in postmenopausal women with breast cancer: a prospective long-term study using transvaginal ultrasound. J Clin Oncol 2000; 18: 3464-3470
  • 71 Fung MF, Reid A, Faught W. et al. Prospective longitudinal study of ultrasound screening for endometrial abnormalities in women with breast cancer receiving tamoxifen. Gynecol Oncol 2003; 91: 154-159
  • 72 Pennant ME, Mehta R, Moody P. et al. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG 2016; 124: 404-411
  • 73 Huang GS, Gebb JS, Einstein MH. et al. Accuracy of preoperative endometrial sampling for the detection of high-grade endometrial tumors. Am J Obstet Gynecol 2007; 196: 243.e1-243.e5
  • 74 Leitao jr. MM, Kehoe S, Barakat RR. et al. Accuracy of preoperative endometrial sampling diagnosis of FIGO grade 1 endometrial adenocarcinoma. Gynecol Oncol 2008; 111: 244-248
  • 75 Clark TJ, Mann CH, Shah N. et al. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review (Structured abstract). BJOG 2002; 109: 313-321
  • 76 Al-Azemi M, Labib NS, Motawy MM. et al. Prevalence of endometrial proliferation in pipelle biopsies in tamoxifen-treated postmenopausal women with breast cancer in Kuwait. Med Princ Pract 2003; 13: 30-34
  • 77 Timmermans A, Opmeer BC, Khan KS. et al. Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: a systematic review and meta-analysis. Obstet Gynecol 2010; 116: 160-167
  • 78 Savelli L, Ceccarini M, Ludovisi M. et al. Preoperative local staging of endometrial cancer: transvaginal sonography vs. magnetic resonance imaging. Ultrasound Obstet Gynecol 2008; 31: 560-566
  • 79 Endometriumcarcinoom. 2011. Zugriff am 25. Juli 2023 unter: https://www.oncoline.nl/endometriumcarcinoom
  • 80 Lalwani N, Dubinsky T, Javitt MC. et al. ACR Appropriateness Criteria(®) pretreatment evaluation and follow-up of endometrial cancer. Ultrasound Q 2014; 30: 21-28
  • 81 Selman TJ, Mann CH, Zamora J. et al. A systematic review of tests for lymph node status in primary endometrial cancer. BMC Womens Health 2008; 8: 8
  • 82 Chang MC, Chen JH, Liang JA. et al. 18F-FDG PET or PET/CT for detection of metastatic lymph nodes in patients with endometrial cancer: a systematic review and meta-analysis. Eur J Radiol 2012; 81: 3511-3517
  • 83 Kakhki VR, Shahriari S, Treglia G. et al. Diagnostic performance of fluorine 18 fluorodeoxyglucose positron emission tomography imaging for detection of primary lesion and staging of endometrial cancer patients: systematic review and meta-analysis of the literature. Int J Gynecol Cancer 2013; 23: 1536-1543
  • 84 Antonsen SL, Jensen LN, Loft A. et al. MRI, PET/CT and ultrasound in the preoperative staging of endometrial cancer – a multicenter prospective comparative study. Gynecol Oncol 2012; 128: 300-308
  • 85 León-Castillo A, de Boer SM, Powell ME. et al. Molecular Classification of the PORTEC-3 Trial for High-Risk Endometrial Cancer: Impact on Prognosis and Benefit From Adjuvant Therapy. J Clin Oncol 2020; 38: 3388-3397
  • 86 Stelloo E, Nout RA, Osse EM. et al. Improved Risk Assessment by Integrating Molecular and Clinicopathological Factors in Early-stage Endometrial Cancer-Combined Analysis of the PORTEC Cohorts. Clin Cancer Res 2016; 22: 4215-4224
  • 87 Wortman BG, Creutzberg CL, Putter H. et al. Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy. Br J Cancer 2018; 119: 1067-1074
  • 88 Reijnen C, Küsters-Vandevelde HVN, Prinsen CF. et al. Mismatch repair deficiency as a predictive marker for response to adjuvant radiotherapy in endometrial cancer. Gynecol Oncol 2019; 154: 124-130
  • 89 Bosse T, Peters EE, Creutzberg CL. et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer–A pooled analysis of PORTEC1 and 2 trials. Eur J Cancer 2015; 51: 1742-1750
  • 90 Kandoth C, McLellan MD, Vandin F. et al. Mutational landscape and significance across 12 major cancer types. Nature 2013; 502: 333-339
  • 91 Coll-de la Rubia E, Martinez-Garcia E, Dittmar G. et al. Prognostic Biomarkers in Endometrial Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9: 1900
  • 92 León-Castillo A, de Boer SM, Powell ME. et al. Molecular Classification of the PORTEC-3 Trial for High-Risk Endometrial Cancer: Impact on Prognosis and Benefit From Adjuvant Therapy. J Clin Oncol 2020; 38: 3388-3397
  • 93 Wortman BG, Creutzberg CL, Putter H. et al. Ten-year results of the PORTEC-2 trial for high-intermediate risk endometrial carcinoma: improving patient selection for adjuvant therapy. Br J Cancer 2018; 119: 1067-1074
  • 94 Bosse T, Nout RA, McAlpine JN. et al. Molecular Classification of Grade 3 Endometrioid Endometrial Cancers Identifies Distinct Prognostic Subgroups. Am J Surg Pathol 2018; 42: 561-568
  • 95 Kommoss S, McConechy MK, Kommoss F. et al. Final validation of the ProMisE molecular classifier for endometrial carcinoma in a large population-based case series. Ann Oncol 2018; 29: 1180-1188
  • 96 Kandoth C, Schultz N, Cherniack AD. et al. Integrated genomic characterization of endometrial carcinoma. Nature 2013; 497: 67-73
  • 97 Wortman BG, Bosse T, Nout RA. et al. Molecular-integrated risk profile to determine adjuvant radiotherapy in endometrial cancer: Evaluation of the pilot phase of the PORTEC-4a trial. Gynecol Oncol 2018; 151: 69-75
  • 98 Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15: 10-17
  • 99 Lax SF, Kurman RJ. A dualistic model for endometrial carcinogenesis based on immunohistochemical and molecular genetic analyses. Verh Dtsch Ges Pathol 1997; 81: 228-232
  • 100 Lax SF, Kurman RJ, Pizer ES. et al. A binary architectural grading system for uterine endometrial endometrioid carcinoma has superior reproducibility compared with FIGO grading and identifies subsets of advance-stage tumors with favorable and unfavorable prognosis. Am J Surg Pathol 2000; 24: 1201-1208
  • 101 Lax SF. Molecular genetic pathways in various types of endometrial carcinoma: from a phenotypical to a molecular-based classification. Virchows Arch 2004; 444: 213-223
  • 102 Wittekind C, Meyer HJ. TNM Klassifikation maligner Tumoren. Weinheim: Wiley-VCH; 2010
  • 103 de Jonge MM, Ritterhouse LL, de Kroon CD. et al. HEBON Group. Germline BRCA-Associated Endometrial Carcinoma Is a Distinct Clinicopathologic Entity. Clin Cancer Res 2019; 25: 7517-7526
  • 104 Van Gool IC, Ubachs JEH, Stelloo E. et al. Blinded histopathological characterisation of POLE exonuclease domain-mutant endometrial cancers: sheep in wolfʼs clothing. Histopathology 2018; 72: 248-258
  • 105 Vermij L, Smit V, Nout R. et al. Incorporation of molecular characteristics into endometrial cancer management. Histopathology 2020; 76: 52-63
  • 106 Casey L, Singh N. POLE, MMR, and MSI Testing in Endometrial Cancer: Proceedings of the ISGyP Companion Society Session at the USCAP 2020 Annual Meeting. Int J Gynecol Pathol 2021; 40: 5-16
  • 107 Talhouk A, Hoang LN, McConechy MK. et al. Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment. Gynecol Oncol 2016; 143: 46-53
  • 108 Lax SF. Pathology of Endometrial Carcinoma. In: Hedrick Ellenson L, ed. Molecular Genetics of Endometrial Carcinoma. Cham: Springer International Publishing;; 2017: 75-96
  • 109 Talhouk A, McConechy MK, Leung S. et al. A clinically applicable molecular-based classification for endometrial cancers. Br J Cancer 2015; 113: 299-310
  • 110 Jönsson JM, Bååth M, Björnheden I. et al. Homologous Recombination Repair Mechanisms in Serous Endometrial Cancer. Cancers (Basel) 2021; 13: 254
  • 111 Concin N, Matias-Guiu X, Vergote I. et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2021; 31: 12-39
  • 112 ten Broeke SW, Brohet RM, Tops CM. et al. Lynch syndrome caused by germline PMS2 mutations: delineating the cancer risk. J Clin Oncol 2014; 33: 319-325
  • 113 Buchanan DD, Tan YY, Walsh MD. et al. Tumor mismatch repair immunohistochemistry and DNA MLH1 methylation testing of patients with endometrial cancer diagnosed at age younger than 60 years optimizes triage for population-level germline mismatch repair gene mutation testing. J Clin Oncol 2013; 32: 90-100
  • 114 Carcangiu ML, Radice P, Casalini P. et al. Lynch syndrome–related endometrial carcinomas show a high frequency of nonendometrioid types and of high FIGO grade endometrioid types. Int J Surg Pathol 2009; 18: 21-26
  • 115 Dowty JG, Win AK, Buchanan DD. et al. Cancer risks for MLH1 and MSH2 mutation carriers. Hum Mutat 2012; 34: 490-497
  • 116 Egoavil C, Alenda C, Castillejo A. et al. Prevalence of Lynch syndrome among patients with newly diagnosed endometrial cancers. PLoS One 2013; 8: e79737
  • 117 Hampel H, Frankel W, Panescu J. et al. Screening for Lynch syndrome (hereditary nonpolyposis colorectal cancer) among endometrial cancer patients. Cancer Res 2006; 66: 7810-7817
  • 118 Leenen CH, van Lier MG, van Doorn HC. et al. Prospective evaluation of molecular screening for Lynch syndrome in patients with endometrial cancer </= 70 years. Gynecol Oncol 2012; 125: 414-420
  • 119 Lu KH, Schorge JO, Rodabaugh KJ. et al. Prospective determination of prevalence of lynch syndrome in young women with endometrial cancer. J Clin Oncol 2007; 25: 5158-5164
  • 120 Westin SN, Lacour RA, Urbauer DL. et al. Carcinoma of the lower uterine segment: a newly described association with Lynch syndrome. J Clin Oncol 2008; 26: 5965-5971
  • 121 Win AK, Lindor NM, Winship I. et al. Risks of colorectal and other cancers after endometrial cancer for women with Lynch syndrome. J Natl Cancer Inst 2013; 105: 274-279
  • 122 Hampel H, de la Chapelle A. The search for unaffected individuals with Lynch syndrome: do the ends justify the means?. Cancer Prev Res (Phila) 2011; 4: 1-5
  • 123 Win AK, Jenkins MA, Dowty JG. et al. Prevalence and Penetrance of Major Genes and Polygenes for Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2017; 26: 404-412
  • 124 Nelen MR, Kremer H, Konings IB. et al. Novel PTEN mutations in patients with Cowden disease: absence of clear genotype-phenotype correlations. Eur J Hum Genet 1999; 7: 267-273
  • 125 Ryan NAJ, Glaire MA, Blake D. et al. The proportion of endometrial cancers associated with Lynch syndrome: a systematic review of the literature and meta-analysis. Genet Med 2019; 21: 2167-2180
  • 126 Snowsill TM, Ryan NAJ, Crosbie EJ. et al. Cost-effectiveness analysis of reflex testing for Lynch syndrome in women with endometrial cancer in the UK setting. PLoS One 2019; 14: e0221419
  • 127 Dominguez-Valentin M, Sampson JR, Seppälä TT. et al. Cancer risks by gene, age, and gender in 6350 carriers of pathogenic mismatch repair variants: findings from the Prospective Lynch Syndrome Database. Genet Med 2020; 22: 15-25
  • 128 Riegert-Johnson DL, Gleeson FC, Roberts M. et al. Cancer and Lhermitte-Duclos disease are common in Cowden syndrome patients. Hered Cancer Clin Pract 2010; 8: 6
  • 129 Tan MH, Mester JL, Ngeow J. et al. Lifetime cancer risks in individuals with germline PTEN mutations. Clin Cancer Res 2012; 18: 400-407
  • 130 Hampel H, Frankel W, Panescu J. et al. Screening for Lynch syndrome (hereditary nonpolyposis colorectal cancer) among endometrial cancer patients. Cancer Res 2006; 66: 7810-7817
  • 131 Ferguson SE, Aronson M, Pollett A. et al. Performance characteristics of screening strategies for Lynch syndrome in unselected women with newly diagnosed endometrial cancer who have undergone universal germline mutation testing. Cancer 2014; 120: 3932-3939
  • 132 Leenen CH, van Lier MG, van Doorn HC. et al. Prospective evaluation of molecular screening for Lynch syndrome in patients with endometrial cancer = 70 years. Gynecol Oncol 2012; 125: 414-420
  • 133 Bubien V, Bonnet F, Brouste V. et al. High cumulative risks of cancer in patients with PTEN hamartoma tumour syndrome. J Med Genet 2013; 50: 255-263
  • 134 Clarke BA, Cooper K. Identifying Lynch syndrome in patients with endometrial carcinoma: shortcomings of morphologic and clinical schemas. Adv Anat Pathol 2012; 19: 231-238
  • 135 Snowsill T, Huxley N, Hoyle M. et al. A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome. Health Technol Assess 2014; 18: 1-406
  • 136 Auranen A, Joutsiniemi T. A systematic review of gynecological cancer surveillance in women belonging to hereditary nonpolyposis colorectal cancer (Lynch syndrome) families. Acta Obstet Gynecol Scand 2011; 90: 437-444
  • 137 Lecuru F, Le Frere Belda MA, Bats AS. et al. Performance of office hysteroscopy and endometrial biopsy for detecting endometrial disease in women at risk of human non-polyposis colon cancer: a prospective study. Int J Gynecol Cancer 2008; 18: 1326-1331
  • 138 Mohile SG, Dale W, Somerfield MR. et al. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. J Clin Oncol 2018; 36: 2326-2347
  • 139 Decoster L, Van Puyvelde K, Mohile S. et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†. Ann Oncol 2015; 26: 288-300
  • 140 Nadaraja S, Jørgensen TL, Matzen LE. et al. Impact of Age, Comorbidity, and FIGO Stage on Treatment Choice and Mortality in Older Danish Patients with Gynecological Cancer: A Retrospective Register-Based Cohort Study. Drugs Real World Outcomes 2018; 5: 225-235
  • 141 Bourgin C, Saidani M, Poupon C. et al. Endometrial cancer in elderly women: Which disease, which surgical management? A systematic review of the literature. Eur J Surg Oncol 2016; 42: 166-175
  • 142 Driver JA, Viswanathan AN. Frailty measure is more predictive of outcomes after curative therapy for endometrial cancer than traditional risk factors in women 60 and older. Gynecol Oncol 2017; 145: 526-530
  • 143 Ahmed A, Deng W, Tew W. et al. Pre-operative assessment and post-operative outcomes of elderly women with gynecologic cancers, primary analysis of NRG CC-002: An NRG oncology group/gynecologic oncology group study. Gynecol Oncol 2018; 150: 300-305
  • 144 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). S3-Leitlinie Mammakarzinom, Langversion 4.3, AWMF-Registernummer: 032–045OL. 2020. Zugriff am 22. Juli 2023 unter: https://www.leitlinienprogramm-onkologie.de/leitlinien/mammakarzinom/
  • 145 Bauer J, Denkinger M, Freiberger E. et al. S1-Leitlinie „Geriatrisches Assessment der Stufe 2. 2019. Zugriff am 02. Juni 2023 unter: https://www.awmf.org/leitlinien/detail/ll/084-002.html