Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.
Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
J Clin Oncol. 2021 Oct 10;39(29):3293-3305. doi: 10.1200/JCO.21.00535. Epub 2021 Jul 1.
Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics.
A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324). Likelihood of pregnancy after BC, their reproductive outcomes, and maternal safety were assessed. Pooled relative risks, odds ratios (ORs), and hazard ratios (HRs) with 95% CIs were calculated using random effects models.
Of 6,462 identified records, 39 were included involving 8,093,401 women from the general population and 112,840 patients with BC of whom 7,505 had a pregnancy after diagnosis. BC survivors were significantly less likely to have a subsequent pregnancy compared with the general population (relative risk, 0.40; 95% CI, 0.32 to 0.49). Risks of caesarean section (OR, 1.14; 95% CI, 1.04 to 1.25), low birth weight (OR, 1.50; 95% CI, 1.31 to 1.73), preterm birth (OR, 1.45; 95% CI, 1.11 to 1.88), and small for gestational age (OR, 1.16; 95% CI, 1.01 to 1.33) were significantly higher in BC survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. Compared to patients with BC without subsequent pregnancy, those with a pregnancy had better disease-free survival (HR, 0.66; 95% CI, 0.49 to 0.89) and overall survival (HR, 0.56; 95% CI, 0.45 to 0.68). Similar results were observed after correcting for potential confounders and irrespective of patient, tumor, and treatment characteristics, pregnancy outcome, and timing of pregnancy.
These results provide reassuring evidence on the safety of conceiving in BC survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.
许多患者和医生仍然担心乳腺癌（BC）后妊娠对生殖结局和母婴安全的潜在不利影响。本系统评价和荟萃分析旨在提供这些主题的最新证据。
进行了系统的文献检索，以确定包括 BC 后妊娠（PROSPERO 编号 CRD42020158324）的患者的研究。评估了 BC 后妊娠的可能性、她们的生殖结局和母婴安全。使用随机效应模型计算了汇总相对风险、优势比（ORs）和风险比（HRs）及其 95%置信区间。
在 6462 条记录中，有 39 项研究符合纳入标准，共纳入 8093401 名来自普通人群的女性和 112840 名 BC 患者，其中 7505 名患者在诊断后怀孕。与普通人群相比，BC 幸存者怀孕的可能性显著降低（相对风险，0.40；95%CI，0.32 至 0.49）。BC 幸存者剖宫产（OR，1.14；95%CI，1.04 至 1.25）、低出生体重（OR，1.50；95%CI，1.31 至 1.73）、早产（OR，1.45；95%CI，1.11 至 1.88）和小于胎龄儿（OR，1.16；95%CI，1.01 至 1.33）的风险显著更高，尤其是在那些有既往化疗暴露的患者中，与普通人群相比。未观察到先天性畸形或其他生殖并发症的风险显著增加。与未后续妊娠的 BC 患者相比，妊娠患者的无病生存率（HR，0.66；95%CI，0.49 至 0.89）和总生存率（HR，0.56；95%CI，0.45 至 0.68）更好。在纠正潜在混杂因素以及无论患者、肿瘤和治疗特征、妊娠结局和妊娠时间如何后，均观察到类似的结果。
这些结果为 BC 幸存者妊娠的安全性提供了令人安心的证据。患者的妊娠意愿应被视为其生存护理计划的重要组成部分。
