Department of Pharmacy, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China.
J Gynecol Oncol. 2024 Nov;35(6):e74. doi: 10.3802/jgo.2024.35.e74. Epub 2024 Mar 11.
The study aimed to review the oncological characteristics and treatment of pregnancy-associated cancers and analyze the obstetric and neonatal outcomes to provide evidence-based recommendations for reproductive function preservation, oncological treatment, and obstetric management.
We conducted an observational retrospective cohort study among pregnant patients with cancer in 7 Chinese tertiary A hospitals from 2003 to 2021. We conducted multiple logistic regression to determine the influence of various factors on preterm birth and small-for-gestational-age infants, log-binomial regression to analyze temporal changes, and χ² tests to explore the effects of cancer type/treatment.
Of 204 women, 17% terminated their pregnancies; 59% received pre-delivery treatment. Every 6 years, the rates of pregnancy termination (relative risk [RR]=0.48; 95% confidence interval [CI]=0.35-0.67) and iatrogenic preterm births (RR=0.73; 95% CI=0.54-0.98) reduced, and that of pre-delivery treatment increased, mainly due to increased rates of surgery (RR=1.87; 95% CI=1.31-2.67). Maternal systemic diseases were related to small-for-gestational-age infants (odds ratio [OR]=12.02; 95% CI=1.82-79.43). Chemotherapy with taxanes plus platinum-based agents was related to adverse obstetric outcomes (OR=1.87; 95% CI=1.42-2.46; p<0.05). Thyroid (OR=0.36; 95% CI=0.22-0.57) and ovarian cancer (OR=0.70; 95% CI=0.50-0.98) were associated with fewer cesarean sections. Thyroid cancer was associated with fetal growth restriction (OR=5.21; 95% CI=1.21-22.55).
Rates of pregnancy termination in cancer declined. Taxane plus platinum-based chemotherapy was associated with adverse obstetric outcomes. Cancer type influenced outcomes.
Chinese Clinical Trial Register Identifier: ChiCTR2100044292.
本研究旨在回顾妊娠相关癌症的肿瘤学特征和治疗方法，并分析产科和新生儿结局，为生殖功能保存、肿瘤治疗和产科管理提供循证建议。
我们在中国 7 家三级 A 医院对 2003 年至 2021 年期间患有癌症的孕妇进行了一项观察性回顾性队列研究。我们采用多因素逻辑回归确定了各种因素对早产和小于胎龄儿的影响，采用对数二项式回归分析时间变化，采用卡方检验探讨癌症类型/治疗的影响。
204 名女性中，17%终止妊娠；59%接受产前治疗。每 6 年，终止妊娠率（相对风险 [RR]=0.48；95%置信区间 [CI]=0.35-0.67）和医源性早产率（RR=0.73；95% CI=0.54-0.98）下降，产前治疗率上升，主要原因是手术率增加（RR=1.87；95% CI=1.31-2.67）。母体系统性疾病与小于胎龄儿有关（比值比 [OR]=12.02；95% CI=1.82-79.43）。紫杉烷类加铂类药物化疗与不良产科结局相关（OR=1.87；95% CI=1.42-2.46；p<0.05）。甲状腺癌（OR=0.36；95% CI=0.22-0.57）和卵巢癌（OR=0.70；95% CI=0.50-0.98）与剖宫产术减少有关。甲状腺癌与胎儿生长受限有关（OR=5.21；95% CI=1.21-22.55）。
癌症患者终止妊娠的比例下降。紫杉烷类加铂类药物化疗与不良产科结局相关。癌症类型影响结局。
中国临床试验注册中心标识符：ChiCTR2100044292。
