van der Vange N, Weverling G J, Ketting B W, Ankum W M, Samlal R, Lammes F B
Department of Obstetrics and Gynecology, University of Amsterdam, The Netherlands.
Obstet Gynecol. 1995 Jun;85(6):1022-6. doi: 10.1016/0029-7844(95)00059-Z.
To assess the effect of pregnancy on the prognosis of cervical cancer and the morbidity of standard treatment.
We analyzed 44 women with cervical carcinoma associated with pregnancy, who were matched with 44 controls. Matching criteria were age, stage of disease (according to the International Federation of Gynecology and Obstetrics classification), tumor type, treatment modality, and period of treatment.
In 23 cases, cervical cancer was diagnosed during pregnancy and in the other 21 cases, within 6 months after delivery. Thirty-nine women had early-stage disease (eight IA, 25 IB, and six IIA), and five had advanced stages (four IIB and one IIIB). The overall 5-year survival rate was 80% among subjects and 82% among controls, whereas the relative risk (RR) of dying within 5 years was 1.12 (95% confidence interval [CI] 0.48-2.65). With regard to the 5-year survival rate (85% for both subjects and controls, the RR of dying was 1.00 [95% CI 0.35-2.83]); no differences were found between subjects and controls for early-stage cervical carcinoma. The size of the group with advanced-stage cervical carcinoma was too small to allow any statistical analysis. No statistically significant differences in survival were observed between cases diagnosed during pregnancy and cases diagnosed after delivery. In addition, the mode of delivery had no effect on survival. Early complications within 6 weeks after treatment were seen 33 times in 25 subjects and 29 times in 23 controls. No differences were observed in the prevalence and type of early complications in subjects versus controls. Late complications after 6 weeks of treatment were seen nine times in nine subjects and 11 times in ten controls. No significant differences were observed in the prevalence and type of late complications in subjects versus controls.
The prognosis of early-stage cervical cancer is similar in pregnant and nonpregnant patients when standard treatment is given. Because of the limited number of patients, no conclusions can be drawn about advanced-stage cervical cancer. The goal should be standard oncologic treatment, which does not lead to increased morbidity in pregnant patients.
评估妊娠对宫颈癌预后及标准治疗发病率的影响。
我们分析了44例妊娠合并宫颈癌的女性，并与44例对照进行匹配。匹配标准为年龄、疾病分期（根据国际妇产科联盟分类）、肿瘤类型、治疗方式和治疗时期。
23例在孕期诊断为宫颈癌，另外21例在产后6个月内诊断。39例女性为早期疾病（8例IA期、25例IB期和6例IIA期），5例为晚期（4例IIB期和1例IIIB期）。研究对象的总体5年生存率为80%，对照组为82%，而5年内死亡的相对风险（RR）为1.12（95%置信区间[CI]0.48 - 2.65）。关于5年生存率（研究对象和对照组均为85%，死亡RR为1.00[95%CI 0.35 - 2.83]）；早期宫颈癌的研究对象与对照组之间未发现差异。晚期宫颈癌组的样本量太小，无法进行任何统计分析。孕期诊断的病例与产后诊断的病例之间在生存率上未观察到统计学显著差异。此外，分娩方式对生存率无影响。治疗后6周内的早期并发症在25例研究对象中出现33次，在23例对照组中出现29次。研究对象与对照组在早期并发症的发生率和类型上未观察到差异。治疗6周后的晚期并发症在9例研究对象中出现9次，在10例对照组中出现11次。研究对象与对照组在晚期并发症的发生率和类型上未观察到显著差异。
给予标准治疗时，妊娠和非妊娠患者早期宫颈癌的预后相似。由于患者数量有限，关于晚期宫颈癌无法得出结论。目标应是标准的肿瘤治疗，这不会导致妊娠患者发病率增加。
