Halaska Michael J, Uzan Catherine, Han Sileny N, Fruscio Robert, Dahl Steffensen Karina, Van Calster Ben, Stankusova Hana, Marchette Martina Delle, Mephon Astrid, Rouzier Roman, Witteveen Petronella O, Vergani Patrizia, Van Calsteren Kristina, Rob Lukas, Amant Frederic
Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic.
Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France.
Int J Gynecol Cancer. 2019 May 7;29(4):676-682. doi: 10.1136/ijgc-2018-000103.
Treatment of cervical cancer during pregnancy is often complex and challenging. This study aimed to analyze current patterns of practice in the management of pregnant patients diagnosed with cervical cancer.
This was a matched cohort study comprising patients managed for cervical cancer during pregnancy from six European centers. Patient information was retrieved from the dataset of the International Network for Cancer, Infertility and Pregnancy from 1990 to 2012. Each center matched its patients with two non-pregnant controls for age (±5 years) and International Federation of Gynecology and Obstetrics (FIGO) 2009 stage. Information on age, histological type, grade, lymphovascular space invasion, stage, tumor size, method of diagnosis, site of recurrence, delivery, date of recurrence, and date of death was recorded. Progression-free survival was compared using multivariable Cox proportional hazards regression.
A total of 132 pregnant patients and 256 controls were analyzed. The pregnant patients (median age 34 years, range 21-43) were diagnosed at a median gestational age of 18.4 weeks of pregnancy (range 7-39). Stage distribution during pregnancy was 14.4% for stage IA, 47.0% for IB1, 18.9% for IB2, and 19.7% for II-IV. For treatment during pregnancy, 17.4% of the patients underwent surgery, 16.7% received neoadjuvant chemotherapy, 26.5% delayed their treatment, 12.9% had a premature delivery, and 26.5% had their pregnancy terminated. Median follow-up was 84 months (67 months for pregnant and 95 months for non-pregnant patients). The unadjusted hazard ratio of pregnancy for progression-free survival was 1.18 (95% confidence interval 0.74 to 1.88).
Surgery and chemotherapy is increasingly used in the management of pregnant patients with cervical cancer and prognosis is similar to that of non-pregnant patients.
孕期宫颈癌的治疗通常复杂且具有挑战性。本研究旨在分析诊断为宫颈癌的孕妇管理中的当前实践模式。
这是一项匹配队列研究，纳入了来自六个欧洲中心的孕期宫颈癌患者。患者信息从1990年至2012年国际癌症、不孕与妊娠网络的数据集中检索。每个中心将其患者与两名年龄（±5岁）和国际妇产科联盟（FIGO）2009分期匹配的非孕妇对照进行匹配。记录年龄、组织学类型、分级、淋巴血管间隙浸润、分期、肿瘤大小、诊断方法、复发部位、分娩、复发日期和死亡日期等信息。使用多变量Cox比例风险回归比较无进展生存期。
共分析了132例孕妇和256例对照。孕妇（中位年龄34岁，范围21 - 43岁）诊断时的中位孕周为18.4周（范围7 - 39周）。孕期分期分布为IA期14.4%，IB1期47.0%，IB2期18.9%，II - IV期19.7%。孕期治疗方面，17.4%的患者接受了手术，16.7%接受了新辅助化疗，26.5%推迟了治疗，12.9%早产，26.5%终止了妊娠。中位随访时间为84个月（孕妇67个月，非孕妇95个月）。妊娠对无进展生存期的未调整风险比为1.18（95%置信区间0.74至1.88）。
手术和化疗在孕期宫颈癌患者管理中的应用越来越多，预后与非孕妇相似。
