Kanbergs Alexa, Clapp Mark, Wu Chi-Fang, Melamed Alexander, Agusti Nuria, Viveros-Carreño David, Zamorano Abigail S, Virili Florencia, Rauh-Hain Jose Alejandro, Nitecki Wilke Roni
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.
Am J Obstet Gynecol. 2025 May;232(5):466.e1-466.e29. doi: 10.1016/j.ajog.2024.10.022. Epub 2024 Oct 22.
Data on maternal and fetal outcomes in patients diagnosed with cancer during pregnancy are limited. Given expected increase in patients diagnosed with cancer during pregnancy, there is a growing need to evaluate clinical outcomes.
To evaluate obstetric outcomes among women with early-stage gynecologic or breast cancer who were diagnosed during pregnancy compared to women without cancer in a population-based cohort.
We performed a population-based study of women aged 18 to 45 years with stage I gynecologic or stage I to III breast cancer reported to the California Cancer Registry for the years 2000 to 2012. Data were linked to the 2000 to 2012 California birth data to produce a database with cancer characteristics and obstetric outcomes. We included patients who had a delivery within the 10 months following cancer diagnosis. The primary outcome was severe maternal morbidity. Secondary outcomes included preterm birth and neonatal morbidity. Propensity scores were used to match similar controls to cases in a 2:1 ratio based on demographic attributes and medical comorbidities included in the Obstetric Comorbidity Index. Logistic regressions were used to evaluate outcomes.
The cohort consisted of 503 women with cancer in pregnancy (319 breast, 125 ovarian, 59 cervical) and 1006 matched controls. Cancer during pregnancy was associated with higher odds of severe maternal morbidity (6.8% vs <1.1%; odds ratio 8.03, 95% confidence interval 3.82-16.88), preterm birth between 32 and 36 weeks (32.6% vs 8.3%, odds ratio 5.38, 95% confidence interval 4.02-7.20), and neonatal morbidity (12.5% vs 6.1%; odds ratio 2.22, 95% confidence interval 1.53-3.21) compared to matched controls. In subanalysis of severe maternal morbidity indicators, hysterectomy and sepsis were significantly associated with cancer during pregnancy (4.8% vs <1.1%, P<.001; <2.2% vs 0.0%, P=.037, respectively).
Cancer during pregnancy is associated with increased risk of maternal and neonatal morbidity. These findings highlight the need for careful management and consideration of obstetric outcomes in these patients.
关于孕期诊断为癌症的患者的母婴结局数据有限。鉴于孕期诊断为癌症的患者预计会增加，评估临床结局的需求日益增长。
在一项基于人群的队列研究中，评估孕期诊断为早期妇科或乳腺癌的女性与未患癌症的女性相比的产科结局。
我们对2000年至2012年向加利福尼亚癌症登记处报告的年龄在18至45岁、患有I期妇科癌症或I至III期乳腺癌的女性进行了一项基于人群的研究。数据与2000年至2012年加利福尼亚州的出生数据相关联，以生成一个包含癌症特征和产科结局的数据库。我们纳入了在癌症诊断后10个月内分娩的患者。主要结局是严重孕产妇发病率。次要结局包括早产和新生儿发病率。倾向评分用于根据产科合并症指数中包含的人口统计学特征和医疗合并症，以2:1的比例将相似的对照组与病例进行匹配。使用逻辑回归来评估结局。
该队列包括503名孕期患癌女性（319例乳腺癌、125例卵巢癌、59例宫颈癌）和1006名匹配的对照组。与匹配的对照组相比,孕期患癌与严重孕产妇发病率较高（6.8% 对 <1.1%；比值比8.03，95%置信区间3.82 - 16.88）、32至36周早产（32.6% 对 8.3%，比值比5.38，95%置信区间4.02 - 7.20）以及新生儿发病率（12.5% 对 6.1%；比值比2.22，95%置信区间1.53 - 3.21）相关。在严重孕产妇发病率指标的亚分析中，子宫切除术和败血症与孕期患癌显著相关（分别为4.8% 对 <1.1%，P <.001；<2.2% 对 0.0%，P = 0.037）。
孕期患癌与孕产妇和新生儿发病风险增加相关。这些发现凸显了对这些患者进行仔细管理并考虑产科结局的必要性。
