Dagogo-Jack Ibiayi, Gainor Justin F, Porter Rebecca L, Schultz Katherine R, Solomon Benjamin J, Stevens Sara, Azzoli Christopher G, Sequist Lecia V, Lennes Inga T, Shaw Alice T
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
J Thorac Oncol. 2016 Sep;11(9):1522-8. doi: 10.1016/j.jtho.2016.05.031. Epub 2016 Jun 11.
Cancer will be diagnosed in one in 1000 women during pregnancy. The outcomes of NSCLC diagnosed during pregnancy are dismal, with most patients dying within 1 year. Actionable mutations are more likely to be found among younger patients with NSCLC. However, most previous reports of NSCLC diagnosed during pregnancy did not include molecular genotyping.
We performed a retrospective analysis of patients seen at our institution between 2009 and 2015 to identify women in whom NSCLC was diagnosed during pregnancy or the peripartum period and determined clinicopathologic features, including molecular genotype.
We identified 2422 women with NSCLC, including 160 women of reproductive age. Among the women of reproductive age, eight cases of NSCLC diagnosed during pregnancy or the peripartum period were identified; all were diagnosed in minimal or never-smokers with metastatic adenocarcinoma. Six of these patients were found to have anaplastic lymphoma kinase gene (ALK) rearrangements, whereas the remaining two were EGFR mutation positive. We observed a borderline significant association between a diagnosis of NSCLC during pregnancy or the peripartum period and ALK positivity (p = 0.053). All eight women in whom NSCLC was diagnosed during pregnancy or the peripartum period received treatment with genotype-directed therapies after delivery. The median overall survival has not been reached at a median follow-up of 30 months.
Although a diagnosis of NSCLC during pregnancy or the peripartum period is rare, diagnostic evaluation should not be delayed in pregnant women presenting with symptoms worrisome for lung cancer. Evaluation should include testing for targetable molecular alterations.
每1000名孕妇中就有1人会被诊断出患有癌症。孕期诊断出的非小细胞肺癌（NSCLC）预后很差，大多数患者在1年内死亡。可操作的突变更有可能在年轻的NSCLC患者中发现。然而，之前大多数关于孕期诊断出NSCLC的报告并未包括分子基因分型。
我们对2009年至2015年在我院就诊的患者进行了回顾性分析，以确定在孕期或围产期被诊断出NSCLC的女性，并确定其临床病理特征，包括分子基因型。
我们确定了2422例NSCLC女性患者，其中包括160名育龄女性。在育龄女性中，确定了8例在孕期或围产期被诊断出的NSCLC；所有患者均被诊断为转移性腺癌的轻度吸烟者或从不吸烟者。其中6例患者被发现有间变性淋巴瘤激酶基因（ALK）重排，而其余2例为表皮生长因子受体（EGFR）突变阳性。我们观察到孕期或围产期诊断出NSCLC与ALK阳性之间存在临界显著关联（p = 0.053）。所有8例在孕期或围产期被诊断出NSCLC的女性在分娩后均接受了基因导向治疗。中位随访30个月时，中位总生存期尚未达到。
虽然孕期或围产期诊断出NSCLC很罕见，但对于出现令人担忧的肺癌症状的孕妇，不应延迟诊断评估。评估应包括检测可靶向的分子改变。
