Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States)
Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States)
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DOI：
10.1023/a:1012229112696
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发表时间：
2001-11-01
影响因子：
2.3
通讯作者：
Robboy, SJ
中科院分区：
文献类型：
--
作者：
Hatch, EE;Herbst, AL;Robboy, SJ
目的：产前接触己烯雌酚(DES)的妇女患阴道和子宫颈透明细胞腺癌的风险较高，但对鳞状肿瘤发病率的影响尚不确定。本研究的目的是评估产前接触DES的妇女发生生殖道高级别鳞状上皮肿瘤的长期风险。方法：对3899名暴露于DES的和1374名未暴露的女儿进行了13年(1982-1995年)的跟踪调查，以获得经病理证实的生殖道高级别鳞状上皮内肿瘤(HSIL)的诊断。使用泊松回归分析计算相对危险度(RR)和95%可信区间(95%CI)，调整年龄、历年和其他协变量。结果：基于111例高度疾病病例，DES暴露和未暴露之间的RR(95%CI)为2.1(1.2-3.8)。根据自上次巴氏涂片检查以来的年数估计的筛查历史调整几乎没有效果。宫内暴露越早，风险估计越高；末次月经后7周内暴露的RR(95%CI)为2.8(1.4-5.5)。总共只发生了两例浸润性宫颈鳞癌，排除了单独的分析。结论：这些发现支持宫内DES暴露与高度鳞状肿瘤之间的联系，尽管不能完全排除在DES暴露的妇女中进行更密集的筛查在产生这种过剩的作用。
Objectives: Women exposed prenatally to diethylstibestrol (DES) have an excess risk of clear-cell adenocarcinoma of the vagina and cervix, but the effect on the incidence of squamous neoplasia is uncertain. The purpose of the current study was to evaluate the long-term risk of developing high-grade squamous neoplasia of the genital tract among women exposed prenatally to DES.Methods: A cohort comprising 3899 DES-exposed and 1374 unexposed daughters was followed for 13 years (1982-1995) for pathology-confirmed diagnoses of high-grade squamous intraepithelial neoplasia (HSIL) of the genital tract. Poisson regression analysis was used to compute relative risks (RR) and 95% confidence intervals (95% CI), adjusting for age, calendar year, and other covariates.Results: The RR (95% CI) among DES-exposed versus unexposed, based on 111 cases of high-grade disease, was 2.1 (1.2-3.8). Adjustment for screening history estimated by the number of years since the last Pap smear had little effect. Risk estimates were higher with earlier intrauterine exposure; the RR (95% CI) for exposure within 7 weeks of the last menstrual period was 2.8 (1.4-5.5). Only two cases of invasive squamous cervical cancer occurred in total, precluding separate analysis.Conclusions: The findings support an association between in-utero DES exposure and high-grade squamous neoplasia, although a role for more intensive screening among DES-exposed women in the production of this excess could not be completely ruled out.