Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3:: population based cohort study
Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3:: population based cohort study
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DOI：
10.1136/bmj.39363.471806.be
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发表时间：
2007-11-24
影响因子：
105.7
通讯作者：
Sparen, Par
中科院分区：
文献类型：
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作者：
Strander, Bjorn;Andersson-Ellstrom, Agneta;Sparen, Par
目的研究宫颈上皮内瘤变3级患者治疗后发生宫颈或阴道浸润癌的远期风险。设计前瞻性队列研究。设置瑞典癌症登记处。研究对象1958-2002年（n=132 493）瑞典所有重度不典型增生或宫颈原位癌（相当于宫颈上皮内瘤变3级）的女性，共治疗2 315 724女性年。主要结果测量标准化的发病率比，以瑞典一般女性人群的癌症风险作为参考，以多变量对数线性回归模型的相对风险作为内部参考。结果与一般女性人群相比，既往宫颈上皮内瘤变3级的女性发生浸润性宫颈癌的风险增加（标准化发病率为2.34，95%可信区间为2.18 ~ 2.50）。对于1970年以后接受治疗的女性，自诊断以来，风险增加呈下降趋势，但25年后风险仍增加。发现年龄的影响，50岁以上妇女的风险增加。自1958年以来，与先前的宫颈上皮内瘤变3级相关的宫颈癌的额外风险稳步增加。阴道癌的标准化发病率比为6.82（5.61比8.21），但25年后降至2.65。多变量对数线性回归模型的调整并没有实质性改变这些结果。结论既往接受过宫颈上皮内瘤变3级治疗的妇女发生浸润性宫颈癌和阴道癌的风险增加。自1960年代以来，这种风险有所增加，在50岁以上的妇女中更为突出。治疗后25年，风险仍在增加。
Objective To study the long term risk of invasive cancer of the cervix or vagina after treatment for cervical intraepithelial neoplasia grade 3. Design Prospective cohort study. Setting Swedish cancer registry. Participants All women in Sweden with severe dysplasia or cervical carcinoma in situ (equivalent to cervical intraepithelial neoplasia grade 3) treated during 1958-2002 (n=132 493) contributing 2 315 724 woman years. Main outcome measures Standardised incidence ratios with risk of cancer in the Swedish general female population as reference and relative risks in multivariable log-linear regression model with internal references. Results Women with previous cervical intraelpithelial neoplasia grade 3 had an increased risk of invasive cervical cancer compared with the general female population (standardised incidence ratio 2.34 95% confidence interval 2.18 to 2.50). The increased risk showed a decreasing trend with time since diagnosis for women treated later than 1970 but the risk was still increased after 25 years. An effect of age was found with an accentuated increase in risk for women aged more than 50. The excess risk for cervical cancer associated with previous cervical intraepithelial neoplasia grade 3 has steadily increased since 1958. For vaginal cancer the standardised incidence ratio was 6.82 (5.61 to 8.21) but this decreased to 2.65 after 25 years. Adjustments in the multivariable log-linear regression model did not substantially alter these results. Conclusions Women previously treated for cervical intraepithelial neoplasia grade 3 are at an increased risk of developing invasive cervical cancer and vaginal cancer. This risk has increased since the 1960s and is accentuated in women aged more than 50. The risk is still increased 25 years after treatment.