癌症孕妇的程序性流产、医疗服务提供者发起的早产及生存情况：一项基于人群的队列研究

Procedural abortion, provider-initiated preterm delivery and survival in pregnant people with cancer: A population-based cohort study.

作者信息

Metcalfe Amy, Cairncross Zoe F, Ray Joel G, Shack Lorraine, Nelson Gregg, Friedenreich Christine M, Sikdar Khokan, Lisonkova Sarka, McMorris Carly A, Bhatti Parveen, Fell Deshayne B

机构信息

Department of Obstetrics and Gynecology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.

出版信息

BJOG. 2025 Jan;132(1):81-88. doi: 10.1111/1471-0528.17937. Epub 2024 Aug 21.

DOI:10.1111/1471-0528.17937

PMID:39169531

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11612611/

Abstract

OBJECTIVE

To assess whether procedural-induced abortion or provider-initiated preterm delivery are associated with improved survival in pregnant people with cancer.

DESIGN

Retrospective population-based cohort study.

SETTING

Provinces of Alberta and Ontario, Canada, 2003-2016.

POPULATION

Females aged 18-50 years diagnosed with cancer at <20 weeks' (for the assessment of procedural-induced abortion) or <37 weeks' gestation (for the assessment of provider-initiated delivery).

METHODS

Cox proportional hazard models assessed all-cause mortality in relation to procedural-induced abortion and provider-initiated preterm delivery, adjusting for cancer site, stage at diagnosis and age. Meta-analysis pooled the results across both provinces.

MAIN OUTCOME MEASURES

All cause mortality.

RESULTS

There were 512 pregnant people diagnosed with cancer at <20 weeks' gestation and 782 diagnosed with cancer at <37 weeks' gestation. Neither procedural-induced abortion (adjusted hazard ratio [aHR] = 1.39, 95% CI: 0.32-6.17) nor provider-initiated preterm delivery (aHR = 1.17, 95% CI: 0.76-1.81) were associated with improved survival following adjustment for age, stage at diagnosis and cancer site.

CONCLUSIONS

Neither procedural-induced abortion nor provider-initiated preterm birth was associated with improved survival in pregnant people diagnosed with cancer; however, these obstetric interventions are highly personal decisions best decided by the pregnant person in consultation with their care providers.

摘要

目的

评估人工流产或由医疗服务提供者发起的早产是否与患癌症孕妇的生存改善相关。

设计

基于人群的回顾性队列研究。

背景

加拿大艾伯塔省和安大略省，2003年至2016年。

研究对象

年龄在18至50岁之间，妊娠小于20周（用于评估人工流产）或小于37周（用于评估医疗服务提供者发起的分娩）时被诊断患有癌症的女性。

方法

Cox比例风险模型评估人工流产和医疗服务提供者发起的早产与全因死亡率的关系，并对癌症部位、诊断时的分期和年龄进行调整。荟萃分析汇总了两个省份的结果。

主要观察指标

全因死亡率。

结果

共有512名妊娠小于20周时被诊断患有癌症的孕妇，以及782名妊娠小于37周时被诊断患有癌症的孕妇。在对年龄、诊断时的分期和癌症部位进行调整后，人工流产（调整后风险比[aHR]=1.39，95%置信区间：0.32-6.17）和医疗服务提供者发起的早产（aHR=1.17，95%置信区间：0.76-1.81）均与生存改善无关。