Современный взгляд на проблему сохранения фертильности у пациенток с атипической гиперплазией эндометрия и ранней стадией рака эндометрия

Подзолкова Н.М., Карпов А.А., Лебедев С.С., Кузнецов Р.Э., Денисова Ю.В., Сычев Д.А., Денисенко Н.П., Тучкова С.Н., Алимов В.А., Данилов А.М., Огурцова Н.Ю., Чижиков Н.П., Закурдаев Е.И. Современный взгляд на проблему сохранения фертильности у пациенток с атипической гиперплазией эндометрия и ранней стадией рака эндометрия. Гинекология. 2026;28(1):48–54. DOI: 10.26442/20795696.2026.1.203597

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Podzolkova NM, Karpov AA, Lebedev SS, Kuznetsov RE, Denisova YuV, Sychev DA, Denisenko NP, Tuchkova SN, Alimov VA, Danilov AM, Ogurtsova NYu, Chizhikov NP, Zakurdaev EI. A modern view of fertility preservation in patients with atypical endometrial hyperplasia and early endometrial cancer. A review. Gynecology. 2026;28(1):48–54. DOI: 10.26442/20795696.2026.1.203597

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Аннотация

Долгое время основным подходом к лечению атипической гиперплазии и ранних стадий рака эндометрия (РЭ) служило радикальное хирургическое вмешательство в объеме пангистерэктомии с/без лимфаденэктомии, обеспечивающее наиболее высокие показатели выживаемости. Ввиду тенденции к откладыванию материнства на фоне демографического кризиса на первый план вышел вопрос сохранения фертильности пациенткам молодого возраста при условии безопасности, эффективности и надлежащего контроля органосохраняющей терапии. Гормонотерапия атипической гиперплазии и начального РЭ сегодня не является новаторской и революционной методикой, однако в последние годы это направление стало развиваться наиболее активно. К настоящему времени в медицинской литературе встречается более 5 режимов гормонального лечения, при этом данные об их сравнительной эффективности неоднозначны и не все они нашли отражение в отечественных клинических рекомендациях. Основные схемы органосохраняющей гормональной терапии: 1) непрерывный пероральный прием медроксипрогестерона ацетата в дозах 160–480 либо 250–500 мг в день; 2) установка внутриматочной системы с левоноргестрелом (ЛНГ-ВМС); 3) подкожные инъекции агонистов гонадотропин-рилизинг-гормона в дозе 3,75 мг 1 раз в 28 дней; 4) пероральный прием гестагенов в сочетании с установкой ЛНГ-ВМС; 5) пероральный прием гестагенов в сочетании с подкожными инъекциями агонистов гонадотропин-рилизинг-гормона. В представленном обзоре собраны новейшие данные, посвященные оценке клинической эффективности и репродуктивных исходов после применения гормональных препаратов изолированно или в комбинациях, а также изучению фармакогенетических биомаркеров ответа на терапию.

Ключевые слова: атипическая гиперплазия эндометрия, рак эндометрия, фертильность, гормонотерапия, фармакогенетика

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For a long time, the primary approach to treating atypical hyperplasia (AEH) and early-stage endometrial cancer (EC) was radical surgery, including panhysterectomy with or without lymphadenectomy, which provided the highest survival rates. In view of the tendency to postpone motherhood against the background of the demographic crisis the issue of preserving fertility in young patients has become paramount, in the case of safety, efficacy and proper control of organ-preserving therapy. Hormonal AEH and early EC therapy is not currently a novel or revolutionary method; however, in recent years this approach has seen significant development. Currently, more than five hormonal treatment regimens are available due to medical literature data, but evidence on their comparative effectiveness are ambiguous, and not all of them are reflected in Russian clinical guidelines. Basic regimens of organ-preserving hormone therapy: 1) continuous oral administration of medroxyprogesterone acetate at doses of 160–480 mg per day or 250–500 mg per day; 2) insertion of an intrauterine system with levonorgestrel (LNG-IUD); 3) subcutaneous injections of gonadotropin-releasing hormone agonists (AGNRH) at a dose of 3.75 mg Q28 days; 4) oral administration of gestagens in combination with LNG-IUD; 5) oral administration of gestagens in combination with subcutaneous injections of AGNRH. This review summarizes the latest data on the clinical efficacy and reproductive outcomes of hormonal AEH and early EC therapy, alone or in combination, and the pharmacogenetic biomarkers of treatment response.

Keywords: atypical endometrial hyperplasia, endometrial cancer, fertility, hormone therapy, pharmacogenetics

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Авторы

Н.М. Подзолкова^1,2, А.А. Карпов^1,2, С.С. Лебедев^1,2, Р.Э. Кузнецов^1,2, Ю.В. Денисова*^1,2, Д.А. Сычев^2,3, Н.П. Денисенко^2,3, С.Н. Тучкова^2,3, В.А. Алимов^1,2, А.М. Данилов¹, Н.Ю. Огурцова¹, Н.П. Чижиков¹, Е.И. Закурдаев¹

¹ГБУЗ «Московский многопрофильный научно-клинический центр им С.П. Боткина» Департамента здравоохранения г. Москвы, Москва, Российская Федерация
²ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Российская Федерация
³ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского», Москва, Российская Федерация
*Yulia.sheveleva.97@mail.ru

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Natalia M. Podzolkova^1,2, Alexey A. Karpov^1,2, Sergey S. Lebedev^1,2, Roman E. Kuznetsov^1,2, Yulia V. Denisova*^1,2, Dmitry A. Sychev^2,3, Natalia P. Denisenko^2,3, Svetlana N. Tuchkova^2,3, Vladimir A. Alimov^1,2, Andrey M. Danilov¹, Natalia Yu. Ogurtsova¹, Nikita P. Chizhikov¹, Evgenij I. Zakurdaev¹

¹Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow, Russian Federation
²Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
³Petrovsky National Research Center of Surgery, Moscow, Russian Federation
*Yulia.sheveleva.97@mail.ru

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