OVARIAN-TUMORS IN A COHORT OF INFERTILE WOMEN
OVARIAN-TUMORS IN A COHORT OF INFERTILE WOMEN
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DOI：
10.1056/nejm199409223311204
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发表时间：
1994-09-22
影响因子：
158.5
通讯作者：
SELF, SG
中科院分区：
文献类型：
--
作者：
ROSSING, MA;DALING, JR;SELF, SG
背景病例报告和最近的病例对照研究的结果提出了关于用于治疗不孕症的药物的潜在肿瘤作用的问题。我们研究了西雅图1974年至1985年间3837名不孕妇女的卵巢肿瘤风险。计算机与基于人群的肿瘤登记处的联系被用来识别1992年1月1日之前诊断出肿瘤的妇女。不孕症检测和治疗的数据是从卵巢癌妇女和随机选择的对照组的医疗记录中提取的。通过年龄标准化比较与普通人群卵巢肿瘤发生率，评估与促排卵药物暴露相关的卵巢肿瘤风险，并采用考克斯回归分析比较接受这些药物治疗的妇女与未接受这些药物治疗的不孕妇女的癌症风险。有11例浸润性或交界性恶性卵巢肿瘤，而预期数量为4.4例（标准化发病率为2.5，95%可信区间为1.3 ~ 4.5）。发生卵巢肿瘤的妇女中有9人服用过克罗米酚;与未服用此药的不孕妇女相比，这些妇女的校正相对危险度为2.3（95%置信区间为0.5 ~ 11.4）。9名女性中有5名在12个或更多个月的周期内服用过这种药物。在卵巢异常和无明显异常的妇女中，这一治疗期与卵巢肿瘤风险增加相关（相对风险为11.1; 95%可信区间为1.5 ~ 82.3），而治疗少于一年与风险增加无关。长期使用克罗米芬可能会增加患交界性或侵袭性卵巢肿瘤的风险。
Background. Case reports and the results of a recent case-control study have raised questions about the potential neoplastic effects of medications used as treatment for infertility.Methods. We examined the risk of ovarian tumors in a cohort of 3837 women evaluated for infertility between 1974 and 1985 in Seattle. Computer linkage with a population-based tumor registry was used to identify women in whom tumors were diagnosed before January 1, 1992. Data on infertility testing and treatment were abstracted from the medical records of women who had ovarian cancer and those of a randomly selected comparison group. The risk of ovarian tumors associated with exposure to ovulation-inducing medications was assessed through an age-standardized comparison with the rate of ovarian tumors in the general population, and Cox regression analysis was used to compare the risk of cancer among women who received these medications with the risk among infertile women who did not receive them.Results. There were 11 invasive or borderline malignant ovarian tumors, as compared with an expected number of 4.4 (standardized incidence ratio, 2.5; 95 percent confidence interval, 1.3 to 4.5). Nine of the women in whom ovarian tumors developed had taken clomiphene; the adjusted relative risk among these women, as compared with that among infertile women who had not taken this drug, was 2.3 (95 percent confidence interval, 0.5 to 11.4). Five of the nine women had taken the drug during 12 or more monthly cycles. This period of treatment was associated with an increased risk of ovarian tumors among both women with ovarian abnormalities and those without apparent abnormalities (relative risk, 11.1; 95 percent confidence interval, 1.5 to 82.3), whereas treatment with the drug for less than one year was not associated with an increased risk.Conclusions. Prolonged use of clomiphene may increase the risk of a borderline or invasive ovarian tumor.