Lau W Y, Leung W T, Ho S, Lam S K, Li C Y, Johnson P J, Williams R, Li A K
Joint Hepatocellular Carcinoma Study Group, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Cancer. 1995 Jun 1;75(11):2669-76. doi: 10.1002/1097-0142(19950601)75:11<2669::aid-cncr2820751105>3.0.co;2-b.
Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) in pregnancy even rarer. The impact of pregnancy on the prognosis of patients with different types of cancer remains controversial. Reported cases of HCC in pregnancy are largely isolated and highly scattered. Thus, the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented.
A series of five patients with HCC in pregnancy seen at two different centers is reported. A Medlar search for articles between 1957 and 1993 with the key words "Hepatocellular Carcinoma" and "Pregnancy" was conducted. All reported cases were combined and analyzed in terms of race, age, parity, hepatitis B surface antigen status, cirrhosis, serum alpha-fetoprotein (AFP) levels at presentation, history of taking oral contraceptive pills and fetal and maternal outcome. The impact of pregnancy on 12 other malignancies as reported in the medical literature also was reviewed.
To the authors' knowledge, The five cases reported here constitute the largest series of HCC in pregnancy. A literature search revealed 23 additional cases. Analysis of the 28 cases suggests that the rarity of HCC in pregnancy results from a combination of three factors: the male predominance of HCC, the late age at which the tumor usually presents in women, and decreased fertility in women with advanced cirrhosis (hepatitis is a predisposing factor for HCC development). Long term use of oral contraceptives and high parity enhance the risk. Elevated AFP level is useful for diagnosis. The median survival is shorter than for patients who are not pregnant. There is no significant difference in survival between pregnant and not pregnant women matched by tumor stage, age, and other clinical parameters in most malignancies except in some tumors like lymphoma, thyroid cancer, and nasopharyngeal carcinoma.
Pregnancy has an adverse effect on the prognosis of patients with HCC, lymphoma, thyroid cancer, and nasopharyngeal carcinoma but not of most other malignancies. Measurement of AFP level is recommended for screening HCC in pregnant women at high risk.
孕期癌症较为罕见，而孕期肝细胞癌（HCC）则更为罕见。孕期对不同类型癌症患者预后的影响仍存在争议。报道的孕期HCC病例大多是孤立的，且分布极为分散。因此，孕期对HCC患者预后的影响以及孕期发生HCC的危险因素尚无充分记录。
报告了在两个不同中心就诊的一系列5例孕期HCC患者。利用Medlar检索1957年至1993年间以“肝细胞癌”和“妊娠”为关键词的文章。将所有报道的病例按照种族、年龄、产次、乙肝表面抗原状态、肝硬化、就诊时血清甲胎蛋白（AFP）水平、口服避孕药史以及胎儿和母亲结局进行合并和分析。还回顾了医学文献中报道的孕期对其他12种恶性肿瘤的影响。
据作者所知，这里报告的5例病例构成了最大的孕期HCC系列。文献检索发现另外23例病例。对这28例病例的分析表明，孕期HCC罕见是由三个因素共同作用导致的：HCC男性居多、该肿瘤在女性中通常出现的年龄较晚，以及晚期肝硬化女性（肝炎是HCC发生的一个诱发因素）生育能力下降。长期使用口服避孕药和高胎次会增加风险。AFP水平升高有助于诊断。中位生存期比未怀孕患者短。在大多数恶性肿瘤中，除了某些肿瘤如淋巴瘤、甲状腺癌和鼻咽癌外，按肿瘤分期、年龄和其他临床参数匹配的怀孕和未怀孕女性在生存率上没有显著差异。
孕期对HCC、淋巴瘤、甲状腺癌和鼻咽癌患者的预后有不利影响，但对大多数其他恶性肿瘤则没有。建议对高危孕妇进行AFP水平检测以筛查HCC。
