Jones W B, Shingleton H M, Russell A, Fremgen A M, Clive R E, Winchester D P, Chmiel J S
Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Cancer. 1996 Apr 15;77(8):1479-88. doi: 10.1002/(SICI)1097-0142(19960415)77:8<1479::AID-CNCR9>3.0.CO;2-7.
The American College of Surgeons conducted a national patient care and evaluation study of invasive cervical carcinoma in pregnant patients.
Invasive cervical carcinoma was diagnosed in 161 patients who were pregnant at the time of diagnosis. A long term study of 78 patients diagnosed in 1984 was compared with a short term study of 83 patients diagnosed in 1990.
The mean age of the patients was 31.8 years. Clinical stages were: IA (29%); IB (54%); IIA (6%); IIB (4%); IIIA (0%); IIIB (3%); IV (1%; AND IVB 3%). Thirty-one percent of patient were diagnosed in the first trimester, 34% in the second, and 35% in the third. A tumor size of 4 cm or larger in diameter was found in 36% of the patients diagnosed in the first trimester, 40% of the patients diagnosed in the second, and 38% of the patients diagnosed in the third. Patients were treated with surgery alone (86), radiotherapy alone (30), or with combination therapy (45). The overall 5-year survival rate for patients diagnosed in 1984 was 82%. In this group, the 5-year survival rate for patients diagnosed in the first trimester was 94.6%, in the second, 76.9%, and in the third, 68.9%. Comparing the two time periods, surgical therapy was performed more often by gynecologic oncologists in 1990 (69% vs. 42%), and a greater percentage of patients were diagnosed with a tumor size of 4 cm or larger in diameter (43% vs. 26%) as well as with stage IIB-IVB disease (15% vs. 6.7%).
The prognosis of pregnant patients with invasive cervical carcinoma is similar to that for nonpregnant patients. The significant number of patients diagnosed in the second and third trimesters and the frequent finding of large tumors in all trimesters emphasize the need for patient education and early prenatal evaluation, including cervical cytology and biopsy of any clinically abnormal cervix.
美国外科医师学会对妊娠患者的浸润性宫颈癌进行了一项全国性患者护理与评估研究。
161例在诊断时处于妊娠状态的患者被诊断为浸润性宫颈癌。将1984年诊断的78例患者的长期研究与1990年诊断的83例患者的短期研究进行比较。
患者的平均年龄为31.8岁。临床分期为：IA期（29%）；IB期（54%）；IIA期（6%）；IIB期（4%）；IIIA期（0%）；IIIB期（3%）；IV期（1%）以及IVB期（3%）。31%的患者在孕早期被诊断，34%在孕中期，35%在孕晚期。在孕早期被诊断的患者中，36%的患者肿瘤直径达到或超过4厘米，孕中期被诊断的患者中这一比例为40%，孕晚期被诊断的患者中为38%。患者接受单纯手术治疗（86例）、单纯放疗（30例）或联合治疗（45例）。1984年诊断的患者总体5年生存率为82%。在该组中，孕早期被诊断的患者5年生存率为94.6%，孕中期为76.9%，孕晚期为68.9%。比较两个时间段，1990年妇科肿瘤学家进行手术治疗的比例更高（69%对42%），且更多患者被诊断为肿瘤直径达到或超过4厘米（43%对26%）以及IIB-IVB期疾病（15%对6.7%）。
妊娠浸润性宫颈癌患者的预后与非妊娠患者相似。大量患者在孕中期和孕晚期被诊断，且在所有孕期均频繁发现大肿瘤，这凸显了患者教育以及早期产前评估的必要性，包括宫颈细胞学检查和对任何临床异常宫颈进行活检。
