Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
BMC Cancer. 2022 Feb 7;22(1):152. doi: 10.1186/s12885-022-09260-6.
Pregnancy-associated breast cancer (PABC) is a rare disease with increasing incidence. The prognosis, pregnancy outcomes and subsequent ovarian function of PABC patients are attracting attention.
Sixty-three PABC patients and 126 age-matched non-PABC patients were obtained in Tongji Hospital from January 2011 to September 2019. The clinical characteristics and ovarian function of PABC patients were compared with those of non-PABC patients. The pregnancy outcomes and neonatal outcomes of patients with breast cancer diagnosed during pregnancy (BCP) were described. Nonparametric tests, the χ2-test Kaplan-Meier, Cox regression and binomial logistic regression were used for analysis.
PABC patients were diagnosed with a more advanced tumour stage (II: 47.6% vs. 45.2%, III: 33.3% vs. 19.8%, IV 3.2% vs. 0%, p = 0.003), which caused worse progression-free survival (PFS) (log-rank p = 0.0138) and breast cancer-specific survival (CSS) (log-rank p = 0.0076) than non-PABC patients. Tumour stage (III/IV vs. 0/I/II) (HR 16.017, 95% CI 5.830 ~ 44.006, p < 0.001) and endocrine therapy (HR 0.254, 95% CI 0.099 ~ 0.653, p = 0.004) were predictors of PFS. Tumour stage (III/IV vs. 0/I/II) (HR 30.875, 95% CI 7.232 ~ 131.820, p < 0.001), endocrine therapy (HR 0.200, 95% CI 0.049 ~ 0.818, p = 0.025) and targeted therapy (HR 0.143, 95% CI 0.028 ~ 0.743, p = 0.021) were predictors for breast CSS. Among the 15 BCP patients, 11 patients voluntarily continued their pregnancy, and the newborns had no obvious birth defects, either in 5 patients who received chemotherapy or in 6 patients who did not receive chemotherapy during pregnancy. Among the patients who received chemotherapy and did not receive endocrine therapy, 24 PABC patients and 48 non-PABC patients experienced chemotherapy-induced amenorrhea. There was no significant difference in resumption of menstruation between the two groups at 6 months and 12 months after the end of chemotherapy. No potential factors affecting resumption of menstruation were found.
Pregnancy at diagnosis or within 1 year after delivery was not a risk factor for a worse prognosis in PABC patients. Compared with non-PABC patients, patients with PABC presented more aggressive tumour characteristics, which could mostly explain the worse prognosis observed in PABC patients. Receiving the appropriate regimen of chemotherapy in the second and third trimesters did not affect the maternal outcomes or neonatal outcomes of BCP patients. The special physiological state during pregnancy and lactation did not interfere with the damage of chemotherapy to ovarian function.
妊娠相关性乳腺癌（PABC）是一种发病率不断上升的罕见疾病。PABC 患者的预后、妊娠结局和后续卵巢功能正受到关注。
本研究纳入了 2011 年 1 月至 2019 年 9 月期间在同济大学附属同济医院确诊的 63 例 PABC 患者和 126 例年龄匹配的非 PABC 患者。比较了 PABC 患者与非 PABC 患者的临床特征和卵巢功能。描述了妊娠期乳腺癌（BCP）患者的妊娠结局和新生儿结局。采用非参数检验、卡方检验、Kaplan-Meier 检验、Cox 回归和二项逻辑回归进行分析。
PABC 患者的肿瘤分期更晚（II 期：47.6% vs. 45.2%，III 期：33.3% vs. 19.8%，IV 期：3.2% vs. 0%，p=0.003），导致无进展生存期（PFS）（log-rank p=0.0138）和乳腺癌特异性生存期（CSS）（log-rank p=0.0076）更差。肿瘤分期（III/IV 期 vs. 0/I/II 期）（HR 16.017，95%CI 5.83044.006，p<0.001）和内分泌治疗（HR 0.254，95%CI 0.0990.653，p=0.004）是 PFS 的预测因素。肿瘤分期（III/IV 期 vs. 0/I/II 期）（HR 30.875，95%CI 7.232131.820，p<0.001）、内分泌治疗（HR 0.200，95%CI 0.0490.818，p=0.025）和靶向治疗（HR 0.143，95%CI 0.028~0.743，p=0.021）是乳腺癌 CSS 的预测因素。在 15 例 BCP 患者中，有 11 例患者自愿继续妊娠，接受化疗的 5 例或未接受化疗的 6 例新生儿均无明显出生缺陷。在接受化疗且未接受内分泌治疗的 24 例 PABC 患者和 48 例非 PABC 患者中，有 24 例发生化疗诱导性闭经。化疗结束后 6 个月和 12 个月，两组恢复月经的差异无统计学意义。未发现影响月经恢复的潜在因素。
诊断时或产后 1 年内妊娠并不是 PABC 患者预后不良的危险因素。与非 PABC 患者相比，PABC 患者表现出更具侵袭性的肿瘤特征，这可能在很大程度上解释了 PABC 患者预后较差的原因。在妊娠第二和第三三期间接受适当的化疗方案并不会影响 BCP 患者的母婴结局或新生儿结局。妊娠和哺乳期的特殊生理状态并未干扰化疗对卵巢功能的损害。
