目的:我们旨在评估女性宫颈和阴道透明细胞腺癌(CCA)的风险,50岁或以上,子宫内暴露于己烯雌酚(DES),并有助于重新评估这些妇女的宫颈癌和阴道癌以及癌前筛查的建议。
方法:我们对癌症研究所的患者进行了回顾性分析。连续研究了两个队列,第一个从1970年到2003年,第二个从2004年到2021年,然后联系起来。
结果:在第一阶段,我们观察到61例CCA,诊断时的平均年龄为23岁(7-42岁),子宫内DES暴露后36例(59%)。在第二阶段,我们发现了27例,在40岁时诊断的女性中,有一例DES暴露(4%)。第二队列的平均年龄为38岁(14-79岁)。对于在CCA诊断时年龄在50岁或以上的七名妇女,5例排除了DES暴露,另外2例被认为不太可能。
结论:总的来说,在癌症中心的51年中观察到88例宫颈或阴道CCA。与DES暴露相关的37例病例约占法国预期的与DES相关的CCA的三分之一。对于年龄在50岁或以上的7例CCA女性,DES暴露是不可能的。这些结果不支持子宫内暴露于DES的女性宫颈或阴道晚期CCA的假设,并表明需要进行更大的多中心研究。就目前而言,我们建议对子宫内暴露于DES的女性进行具体筛查:1)方法:结合细胞学和hrHPV检测,宫颈和阴道取样,2)时间安排:年度,或者不超过三年的间隔,65岁后和子宫切除术后继续。
OBJECTIVE: We aimed to evaluate the risk of cervical and vaginal clear cell adenocarcinoma (CCA) in women, aged 50 years or more, exposed in utero to diethylstilbestrol (DES) and contribute to a reevaluation of the recommendations for cervical and vaginal cancer and pre-cancer screening for these women.
METHODS: We carried out a retrospective review for patients received in a cancer institute. Two cohorts were consecutively studied, the first from 1970 to 2003 and the second from 2004 to 2021, and then linked.
RESULTS: During the first period, we observed 61 CCA cases, with a mean age at diagnosis of 23 years (7-42), 36 (59%) following DES exposure in utero. During the second period, we found 27 cases, with one case of DES exposure (4%) for a women diagnosed at the age of 40 years. The mean age of the second cohort was 38 years (14-79). For the seven women aged 50 years or more at the time of CCA diagnosis, DES exposure was excluded for five and considered unlikely for the other two.
CONCLUSIONS: In total, 88 cases of cervical or vaginal CCA were observed over a period of 51 years in a cancer center. The 37 cases associated with DES exposure represented approximatively one third of the CCA related to DES expected in France. DES exposure was improbable for the seven cases of CCA for women aged 50 years or more. These results do not support the hypothesis of late cervical or vaginal CCA in women exposed to DES in utero and indicate the need for larger multicentric studies. For the present, we propose specific screening for women exposed to DES in utero in terms of : 1) methods: association of cytology and hrHPV testing, with cervical and vaginal sampling, 2) timing : annual, or without exceeding a three-year interval, continuing after 65 years of age and after hysterectomy.