卵巢子宫内膜异位症恶变及Wnt信号通路在这一过程中的研究进展

Research Progress on Malignant Transformation of Ovarian Endometriosis and Wnt Signal Pathways in This Process

摘要: 卵巢子宫内膜异位症(ovarian endometriosis, OE)作为临床上最常见的妇科疾病之一，目前在世界各地约有1.76亿名女性受到该病影响。OE虽然是良性疾病，但其却具备浸润、转移等恶性病变的特征，恶变作为临床上OE最严重的并发症，虽然发生率低，但由于OE患病女性基数较大，OE恶变的病例总数相当可观，因此在国内外受到许多学者的高度重视。目前，许多研究认为，非典型卵巢子宫内膜异位症(atypical endometriosis, aEM)是子宫内膜异位症相关性卵巢癌(endometriosis associated ovarian cancer, EAOC)的癌前病变，OE病变组织中的良性异位子宫内膜细胞可在一定条件下转化为异位子宫内膜非典型增生，且可继续转化为异位子宫内膜恶性病变，但目前OE与EAOC之间的关系未有明确的研究及阐述。目前对EAOC的临床及基础性研究发现雌激素、氧化应激、慢性炎症等因素在其发生发展过程中发挥了重要作用，且PTEN、ARID1A、PIK3CA、miRNA等多种生物信号通路及因子也起到了重要作用。Wnt信号通路是人体细胞增殖凋亡及器官形成过程中的重要细胞信号传导通路，该通路的异常表达可促进人体多种恶性肿瘤的发生与进展。本文通过对OE恶变的研究进展及Wnt信号传导通路在这一过程中的作用进行综述，以期为EAOC的早期筛查、完善该病的分类管理、实现精准的个体化治疗方案等方面提供一定的理论依据，为潜在EAOC患者的早期诊断、早期医疗干预以及改善已确诊EAOC患者的预后提供新思路。

Abstract: Ovarian endometriosis (OE) is one of the most common gynecological diseases in clinical practice. At present, about 176 million women around the world are affected by this disease. Although OE is a benign disease, it has the characteristics of invasion, metastasis and other malignant diseases. As the most serious complication of OE in clinical practice, malignant transformation has a low inci-dence, but due to the large number of women with OE, the total number of cases of malignant trans-formation of OE is considerable, so it has been highly valued by many scholars at home and abroad. At present, many studies believe that atypical ovarian endometriosis (aEM) is a precancerous lesion of endometriosis associated ovarian cancer (EAOC). Benign ectopic endometrial cells in OE lesions can be transformed into atypical hyperplasia of ectopic endometrium under certain conditions, and can continue to be transformed into malignant lesions of ectopic endometrium, However, there is no clear research and elaboration on the relationship between OE and EAOC. At present, clinical and basic studies on EAOC have found that estrogen, oxidative stress, chronic inflammation and other factors play an important role in the occurrence and development of EAOC, and PTEN, ARID1A, PIK3CA, miRNA and other biological signal pathways and factors also play an important role. Wnt signaling pathway is an important cellular signal transduction pathway in the process of human cell proliferation, apoptosis and organ formation. The abnormal expression of this pathway can promote the occurrence and progression of various human malignant tumors. This article reviews the research progress of OE canceration and the role of Wnt signal transduction pathway in this process, with a view to providing some theoretical basis for early screening of EAOC, improving the classification management of the disease, achieving accurate individualized treatment scheme, etc., and providing new ideas for early diagnosis, early medical intervention and improving the prognosis of patients with diagnosed EAOC.