Division of Hematology / Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Cancer Med. 2020 Dec;9(24):9431-9444. doi: 10.1002/cam4.3565. Epub 2020 Oct 25.
Pregnancy-associated cancer (PAC), defined as cancers diagnosed during pregnancy or the first year after delivery, affects one to two in every 1000 pregnancies. Although PAC is expected to be a growing issue, information about PAC in the Asian population is still scarce. Women with cancer diagnosed at the age of 16-49 years between 2001 and 2015 were selected from the Taiwan Cancer Registry and linked with the National Birth Reporting Database to identify PAC patients. We compared the overall survival of patients with PAC to patients without pregnancy. Among 126,646 female cancer patients of childbearing age, 512 were diagnosed during pregnancy, and 2151 during the first postpartum year. Breast cancer was the most common PAC (N = 755, 28%). Compared with patients without pregnancy in the control group, patients with cancers diagnosed during pregnancy and the first postpartum year generally had more advanced stages (odds ratio 1.35 and 1.36, 95% confidence interval [CI] 1.02-1.77 and 1.18-1.57, respectively). For all cancer types combined and controlled for the stage, age, and year of diagnosis, patients with PAC had similar overall survival with those in the control group, with a hazard ratio (HR) of 1.07 (95% CI 0.80-1.41) for the pregnancy group and HR 1.02 (95% CI 0.88-1.18) for the postpartum group. The diagnosis of breast cancer during the first postpartum year was linked with shorter survival (HR 1.34, 95% CI 1.05-1.72). In contrast, patients with postpartum lymphoma (HR 0.11, 95% CI 0.02-0.79) and cervical cancer (HR 0.40, 95% CI 0.20-0.82) had better prognosis. In general, the diagnosis of cancer during pregnancy or the first postpartum year does not affect the survival of patients with most cancer types. Exceptions include the worse prognosis of postpartum breast cancer and the better outcome of postpartum lymphoma and cervical cancer.
妊娠相关癌症（PAC）定义为在怀孕期间或分娩后一年内诊断出的癌症，每 1000 次妊娠中就有 1 至 2 例。尽管 PAC 预计会成为一个日益严重的问题，但亚洲人群中关于 PAC 的信息仍然匮乏。从台湾癌症登记处选择了 2001 年至 2015 年间诊断为 16-49 岁的癌症女性患者，并与国家出生报告数据库进行链接，以确定 PAC 患者。我们比较了 PAC 患者与未妊娠患者的总体生存率。在 126646 名育龄期女性癌症患者中，有 512 例在妊娠期间诊断出癌症，2151 例在产后第一年诊断出癌症。乳腺癌是最常见的 PAC（N=755，28%）。与对照组中未妊娠的患者相比，在妊娠期间和产后第一年诊断出癌症的患者通常处于更晚期（比值比为 1.35 和 1.36，95%置信区间[CI]为 1.02-1.77 和 1.18-1.57）。对于所有癌症类型，并且在控制了阶段、年龄和诊断年份后，PAC 患者的总体生存率与对照组相似，妊娠组的风险比（HR）为 1.07（95%CI 0.80-1.41），产后组为 HR 1.02（95%CI 0.88-1.18）。产后第一年诊断出乳腺癌与生存率缩短相关（HR 1.34，95%CI 1.05-1.72）。相比之下，产后淋巴瘤（HR 0.11，95%CI 0.02-0.79）和宫颈癌（HR 0.40，95%CI 0.20-0.82）患者的预后较好。一般来说，妊娠或产后第一年诊断出癌症不会影响大多数癌症类型患者的生存率。例外情况包括产后乳腺癌的预后较差，以及产后淋巴瘤和宫颈癌的结局较好。
