Association between Estrogen Exposure and Idiopathic Subglottic Stenosis.

Autor: Nanda N; Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A., Huang LC; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A., Chen SC; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A., Berry LD; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A., Talatala ERR; Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, U.S.A., Clark E; Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, U.S.A., Ye W; Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, U.S.A., Gelbard A; Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, U.S.A., Francis DO; Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2024 Feb; Vol. 134 (2), pp. 825-830. Date of Electronic Publication: 2023 Sep 05.
DOI: 10.1002/lary.31030
Abstrakt: Objective: Idiopathic subglottic stenosis (iSGS) is a rare, recurrent, fibroinflammatory disease affecting the larynx and proximal trachea. Given it occurs primarily in adult females, estrogen is speculated to play a central pathophysiological role. This study aimed to evaluate relationships between estrogen exposure, disease progression, and recurrence.
Methods: North American Airway Collaborative (NoAAC) data of adults with iSGS obstructive airway lesions, who underwent index endoscopic airway dilation, were used to identify associations between estrogen exposure, disease characteristics, and time to recurrence (TTR), and interventions were analyzed using Kruskal-Wallis test and Pearson coefficient. Cox proportional hazards regression models compared hazard ratios by estrogen exposure. Kaplan-Meier curves were plotted for TTR based on menopausal status.
Results: In all, 533 females had complete estrogen data (33% premenopausal, 17% perimenopausal, 50% postmenopausal). Median estrogen exposure was 28 years. Overall, there was no dose-response relationship between estrogen exposure and disease recurrence. Premenopausal patients had significantly shorter time from symptom manifestation to diagnosis (1.17 vs. 1.42 years perimenopausal vs. 2.08 years postmenopausal, p < 0.001), shorter time from diagnosis to index endoscopic airway dilation (1.90 vs. 2.50 vs. 3.76 years, p = 0.005), and higher number of procedures (1.73 vs. 1.20 vs. 1.08 procedures, p < 0.001).
Conclusions: We demonstrate premenopausal patients may have a more aggressive disease variant than their peri- and postmenopausal counterparts. However, it is unclear as to whether this is related to reduced estrogen in the peri- and postmenopausal states or the age-related physiology of wound healing and inflammation, regardless of estrogen.
Level of Evidence: 3 Laryngoscope, 134:825-830, 2024.
(© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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