About one-fifth of endometrial cancers are ‘high risk’, which carries a poorer prognosis. Management strategies to optimise their survival have been under investigation for many years. Despite recent advances, their overall survival remains relatively poor. The definition of high risk in endometrial cancers has been based on clinicopathological factors until recently, when molecular profiling has shown greater discrimination. There is, however, poor correlation between traditional clinicopathological factors and their molecular profile. This is the subject of ongoing trials to better individualise adjuvant post-hysterectomy treatment. The management of high-risk tumours is traditionally based on surgery followed by radiotherapy, despite no proven overall survival benefit in early stages. The place of chemotherapy remains under investigation, with recent trials showing benefit in more advanced stages. The Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) and Gynecologic Oncology Group trials support the use of chemoradiation and chemotherapy for stage III and adverse histological subgroups. In addition, there is now early evidence of correlation between benefit from adjuvant chemotherapy based on molecular alterations in the tumour cells. In this review, we look at the current evidence on management strategies in the evolving era of molecular diagnosis and stratification.

大约五分之一的子宫内膜癌属于“高风险”，预后较差。多年来，人们一直在研究优化它们生存的管理策略。尽管最近取得了进展，但他们的总体生存率仍然相对较差。直到最近，当分子谱显示出更大的歧视时，子宫内膜癌高风险的定义一直基于临床病理因素。然而，传统的临床病理因素与其分子特征之间的相关性较差。这是正在进行的试验的主题，以更好地个性化辅助子宫切除术后治疗。高风险肿瘤的管理传统上基于手术后放疗，尽管在早期阶段没有证明总体生存益处。化疗地点还在调查中，最近的试验显示出在更高级阶段的益处。子宫内膜癌术后放射治疗 (PORTEC) 和妇科肿瘤组试验支持对 III 期和不良组织学亚组使用放化疗和化疗。此外，现在有早期证据表明基于肿瘤细胞分子改变的辅助化疗获益之间存在相关性。在这篇综述中，我们着眼于分子诊断和分层不断发展的时代中管理策略的当前证据。现在有早期证据表明基于肿瘤细胞分子改变的辅助化疗获益之间存在相关性。在这篇综述中，我们着眼于分子诊断和分层不断发展的时代中管理策略的当前证据。现在有早期证据表明基于肿瘤细胞分子改变的辅助化疗获益之间存在相关性。在这篇综述中，我们着眼于分子诊断和分层不断发展的时代中管理策略的当前证据。