Mount Sinai Hospital, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Brigham and Women's Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Harvard Medical School, Boston, MA.
Am J Obstet Gynecol. 2017 Mar;216(3):276.e1-276.e6. doi: 10.1016/j.ajog.2016.10.034. Epub 2016 Oct 31.
Cervical cancer is the third most common gynecologic malignancy in the United States. Approximately 1-3% of cervical cancers will be diagnosed in pregnant and peripartum women; optimal management in the setting of pregnancy is not always clear.
We sought to describe the management of patients with cervical cancer diagnosed in pregnancy and compare their outcomes to nonpregnant women with similar baseline characteristics.
We conducted a retrospective chart review of all patients diagnosed with cervical cancer in pregnancy and matched them 1:2 with contemporaneous nonpregnant women of the same age diagnosed with cervical cancer of the same stage. Patients were identified using International Classification of Diseases, Ninth Revision codes and the Dana-Farber/Massachusetts General Hospital Cancer Registry. Data were analyzed using Stata, Version 10.1 (College Station, TX).
In all, 28 women diagnosed with cervical cancer during pregnancy were identified from 1997 through 2013. The majority were Stage IB1. In all, 25% (7/28) of women terminated the pregnancy; these women were more likely to be diagnosed earlier in pregnancy (10.9 vs 19.7 weeks, P = .006). For those who did not terminate, mean gestational age at delivery was 36.1 weeks. Pregnancy complications were uncommon. Complication rates in pregnant women undergoing radical hysterectomy were similar to those outside of pregnancy. Time to treatment was significantly longer for pregnant women compared to nonpregnant patients (20.8 vs 7.9 weeks, P = .0014) but there was no survival difference between groups (89.3% vs 95.2%, P = .08). Women who underwent gravid radical hysterectomy had significantly higher estimated blood loss than those who had a radical hysterectomy in the postpartum period (2033 vs 425 mL, P = .0064), but operative characteristics were otherwise similar. None of the pregnant women who died delayed treatment due to pregnancy.
Gestational age at diagnosis is an important determinant of management of cervical cancer in pregnancy, underscoring the need for expeditious workup of abnormal cervical cytology. Of women who choose to continue the pregnancy, most delivered in the late preterm period without significant obstetric complications. For women undergoing radical hysterectomy in the peripartum period, complication rates are similar to nonpregnant women undergoing this procedure. Women who died were more likely to have advanced stage disease at the time of diagnosis. This information may be useful in counseling women facing the diagnosis of cervical cancer in pregnancy.
宫颈癌是美国第三大常见妇科恶性肿瘤。大约有 1-3%的宫颈癌会在孕妇和围产期妇女中被诊断出；在怀孕期间，最佳的治疗方法并不总是明确的。
我们旨在描述在妊娠期间被诊断为宫颈癌的患者的治疗方法，并将其与具有相似基线特征的非妊娠妇女进行比较。
我们对所有在妊娠期间被诊断为宫颈癌的患者进行了回顾性病历分析，并将其与同期被诊断为相同分期宫颈癌的同年龄非妊娠妇女进行了 1:2 配对。患者通过国际疾病分类，第九版代码和达纳-法伯/麻省总医院癌症登记处确定。使用 Stata 软件，版本 10.1（德克萨斯州学院站）进行数据分析。
总共从 1997 年至 2013 年期间发现了 28 名在妊娠期间被诊断为宫颈癌的妇女。大多数患者处于 IB1 期。总共 25%（7/28）的妇女终止了妊娠；这些妇女在妊娠早期被诊断出的可能性更大（10.9 周 vs 19.7 周，P=0.006）。对于那些未终止妊娠的患者，分娩时的平均孕龄为 36.1 周。妊娠并发症并不常见。在接受根治性子宫切除术的孕妇中，并发症发生率与非妊娠患者相似。与非妊娠患者相比，孕妇的治疗时间明显延长（20.8 周 vs 7.9 周，P=0.0014），但两组之间的生存率无差异（89.3% vs 95.2%，P=0.08）。接受妊娠根治性子宫切除术的妇女的估计出血量明显高于在产后进行根治性子宫切除术的妇女（2033 毫升 vs 425 毫升，P=0.0064），但手术特征相似。没有死于宫颈癌的孕妇因怀孕而延迟治疗。
诊断时的孕龄是妊娠合并宫颈癌治疗的重要决定因素，这强调了对异常宫颈细胞学检查进行快速检查的必要性。对于选择继续妊娠的妇女，大多数在晚期早产期间分娩，没有明显的产科并发症。对于在围产期接受根治性子宫切除术的妇女，并发症发生率与接受该手术的非妊娠妇女相似。死亡的妇女在诊断时更有可能患有晚期疾病。这些信息可能有助于为面临宫颈癌诊断的孕妇提供咨询。
