Eibye Simone, Krüger Kjær Susanne, Nielsen Thor S S, Mellemkjær Lene
*Virus, Lifestyle, and Genes, Danish Cancer Society Research Center; and †Department of Obstetrics and Gynecology, The Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark.
Int J Gynecol Cancer. 2016 Jun;26(5):951-8. doi: 10.1097/IGC.0000000000000708.
Cervical cancer diagnosed in relation to a pregnancy is rare; however, the current trend to have children later in life increases the risk of pregnancy and cervical cancer coinciding. We investigated the mortality of women diagnosed with cervical cancer during or in relation to a pregnancy.
From the nationwide Danish Cancer Registry, we identified women diagnosed with a primary cervical cancer at ages 15 to 44 years during 1968 to 2006 born after April 1, 1935. The women were linked to several Danish national registries to obtain information on births and abortions. In addition, linkage was made to the Cause of Death Register. Overall and cause-specific hazards ratios (HRs) were assessed by Cox proportional hazards regression with adjustment for age, calendar year, and extent of disease.
A total of 6135 cervical cancers were identified. Among these, 126 women were diagnosed with cervical cancer during pregnancy, 1856 were diagnosed with cervical cancer 0 to 4 years after a pregnancy, and 4153 were diagnosed with cervical cancer more than 30 days before or 5 years or more after a pregnancy or had no known pregnancies. The latter group was used as reference. The adjusted HR for death due to cervical cancer was 1.77 (95% confidence interval, 1.21-2.60) among women diagnosed with cervical cancer during pregnancy compared with that in the reference group, while the corresponding HR among women with cervical cancer 0 to 4 years after pregnancy was 0.96 (95% confidence interval, 0.83-1.10) compared with that in the reference group.
Our results suggest an increased mortality for women diagnosed with cervical cancer during pregnancy, but not among those diagnosed shortly after pregnancy. This finding should be explored further in larger populations.
与妊娠相关的宫颈癌诊断罕见;然而,当前晚育的趋势增加了妊娠与宫颈癌同时发生的风险。我们调查了在妊娠期间或与妊娠相关时被诊断为宫颈癌的女性的死亡率。
从丹麦全国癌症登记处,我们确定了1968年至2006年期间年龄在15至44岁、1935年4月1日之后出生且被诊断为原发性宫颈癌的女性。这些女性与丹麦几个国家登记处建立了关联,以获取出生和流产信息。此外,还与死因登记处建立了关联。通过Cox比例风险回归评估总体和特定病因的风险比(HRs),并对年龄、日历年份和疾病范围进行调整。
共识别出6135例宫颈癌。其中,126名女性在妊娠期间被诊断为宫颈癌,1856名在妊娠后0至4年被诊断为宫颈癌,4153名在妊娠前30天以上或妊娠后5年或更长时间被诊断为宫颈癌或无已知妊娠史,后一组用作参考。与参考组相比,妊娠期间被诊断为宫颈癌的女性因宫颈癌死亡的调整后HR为1.77(95%置信区间,1.21 - 2.60),而妊娠后0至4年患宫颈癌的女性与参考组相比相应的HR为0.96(95%置信区间,0.83 - 1.10)。
我们的结果表明,妊娠期间被诊断为宫颈癌的女性死亡率增加,但妊娠后不久被诊断的女性并非如此。这一发现应在更大规模人群中进一步探讨。