Waggoner S E, Mittendorf R, Biney N, Anderson D, Herbst A L
University of Chicago Medical Center, Department of Obstetrics and Gynecology, Illinois 60637.
Gynecol Oncol. 1994 Nov;55(2):238-44. doi: 10.1006/gyno.1994.1284.
Most young women with clear-cell adenocarcinoma (CCA) of the vagina have a history of prenatal exposure to diethylstilbestrol (DES). Some, however, develop vaginal CCA without a prior history of DES exposure. We hypothesized that the natural history of DES-exposed vaginal CCA and DES-unexposed vaginal CCA may differ. Cases were identified from the Registry for Research on Hormonal Transplacental Carcinogenesis which maintains information on cases of CCA of the lower genital tract occurring in women born after 1940. Four hundred and thirty-one cases satisfied FIGO criteria for primary vaginal carcinoma of which 318 had prenatal, hospital, obstetrician, or pharmacy records available for review. Of these, 80% (255/318) had written documentation of prenatal exposure to DES (DES+) and 20% (63/318) had no evidence of DES exposure (DES-) in their medical records. DES exposure was undetermined in 113 cases due to lack of appropriate medical records. Among cases with documentation, DES exposure was not associated with mean age at diagnosis, (DES+, 20.3 years, DES-, 21.1 years), stage (stage I: DES+, 59%, DES-, 54%; stage II: DES+, 32%, DES-, 33%; stage III: DES+, 7%, DES-, 11%; stage IV: DES+, 2%, DES-, 2%, mean tumor diameter or surface area, grade, histology, cell type, or initial therapy. Among cases which underwent pelvic and paraaortic lymph node sampling (DES+, 63%; DES-, 56%; P = NS) the prevalence of pelvic node involvement was similar (DES+, 18.6%; DES-, 17.1%). However, only 1.2% (2/161) of DES+ cases had positive paraaortic lymph nodes compared to 8.6% (3/35) of DES- cases (P = 0.041). Survival differed significantly between the two groups. Probability of survival at 5 and 10 years for DES+ cases was 84 and 78%, respectively, compared to 69 and 60%, respectively, for DES- cases (5 years, P = 0.007, and 10 years, P = 0.008). Presently, 21% (53/255) of DES+ cases are known to have died, compared to 37% (23/63) of DES- cases (P = 0.008). Sites of disease recurrence also differed. DES- cases were more likely than DES+ cases to present with or to later develop distant tumor to the lungs (24% vs 9%; P = 0.002) or metastases to supraclavicular lymph nodes (8% vs 1.6%; P = 0.017). Among the 113 cases with an uncertain history of DES exposure, survival was intermediate between the well-documented cases (79% at 5 years and 65% at 10 years with 35/113 or 31% known dead), as was frequency of metastases to the lungs (13%) or supraclavicular lymph nodes (5.3%).(ABSTRACT TRUNCATED AT 400 WORDS)
大多数患有阴道透明细胞腺癌（CCA）的年轻女性有产前接触己烯雌酚（DES）的病史。然而，有些患者在没有DES接触史的情况下也会发生阴道CCA。我们推测，接触DES的阴道CCA和未接触DES的阴道CCA的自然病史可能不同。病例来自激素经胎盘致癌研究登记处，该登记处保存了1940年后出生女性中发生的下生殖道CCA病例的信息。431例符合国际妇产科联盟（FIGO）原发性阴道癌标准，其中318例有产前、医院、产科医生或药房记录可供查阅。其中，80%（255/318）的病历中有产前接触DES的书面记录（DES+），20%（63/318）的病历中没有DES接触的证据（DES-）。由于缺乏适当的病历，113例病例的DES接触情况未确定。在有记录的病例中，DES接触与诊断时的平均年龄无关（DES+，20.3岁；DES-，21.1岁），与分期（I期：DES+，59%；DES-，54%；II期：DES+，32%；DES-，33%；III期：DES+，7%；DES-，11%；IV期：DES+，2%；DES-，2%）、平均肿瘤直径或表面积、分级、组织学、细胞类型或初始治疗无关。在接受盆腔和腹主动脉旁淋巴结取样的病例中（DES+，63%；DES-，56%；P=无显著性差异），盆腔淋巴结受累的发生率相似（DES+，18.6%；DES-，17.1%）。然而，DES+病例中只有1.2%（2/161）腹主动脉旁淋巴结阳性，而DES-病例中为8.6%（3/35）（P=0.041）。两组的生存率有显著差异。DES+病例5年和10年的生存率分别为84%和78%，而DES-病例分别为69%和60%（5年，P=0.007；10年，P=0.008）。目前，已知DES+病例中有21%（53/255）死亡，而DES-病例中有37%（23/63）死亡（P=0.008）。疾病复发部位也不同。DES-病例比DES+病例更有可能出现或后来发展为肺部远处肿瘤（24%对9%；P=0.002）或锁骨上淋巴结转移（8%对1.6%；P=0.017）。在113例DES接触史不确定的病例中，生存率介于记录完整的病例之间（5年时为79%，10年时为65%，113例中有35例或31%已知死亡），肺部转移（13%）或锁骨上淋巴结转移（5.3%）的频率也是如此。（摘要截断于400字）
