Mingzhu Li1, Yun Zhao1, Mingrong Qie2, Youzhong Zhang3, Longyu Li4, Bei Lin5, Ruixia Guo6, Zhixue You7, Ruifang An8, Jun Liu9, Zhijun Zhang10, Hui Bi11, Ying Hong12, Shufang Chang13, Guoli He14, Keqin Hua15, Qi Zhou16, Qinping Liao17, Yue Wang1, Jianliu Wang1, Xiaoping Li1, Lihui Wei1. 1. Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China. 2. Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China. 3. Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Shandong, China. 4. Department of Obstetrics and Gynecology, Jiangxi Maternal and Child Health Hospital, Nan Chang, China. 5. Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China. 6. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 7. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 8. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi 'An Jiaotong University, Xi'an, China. 9. Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. 10. Department of Obstetrics and Gynecology, Guizhou Provincial People's Hospital, Guiyang, China. 11. Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China. 12. Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing, China. 13. Department of Obstetrics and Gynecology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 14. Department of Obstetrics and Gynecology, Hainan General Hospital, Hainan, China. 15. Department of Obstetrics and Gynecology, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China. 16. Department of Gynecology Oncology, Chongqing University Cancer Hospital, Chongqing, China. 17. Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing, China.
Abstract
Background: This retrospective multi-center study aimed to describe the epidemiological characteristics, clinical features, and management of patients with cervical cancer in pregnancy (CCIP) and evaluate maternal and infant outcomes. Methods: The data of patients with CCIP were retrospectively collected from those diagnosed and treated in 17 hospitals in 12 provinces in China between January 2009 and November 2017. The information retrieved included patients' age, clinical features of the tumor, medical management (during pregnancy or postpartum), obstetrical indicators (i.e., gestational age at diagnosis, delivery mode, and birth weight), and maternal and neonatal outcomes. Survival analyses were performed using Kaplan-Meier survival curves and log-rank tests that estimated the overall survival of patients. Results: One-hundred and five women diagnosed with CCIP (median age = 35 years) were identified from ~45,600 cervical cancer patients (0.23%) and 525,000 pregnant women (0.020%). The median gestational age at cancer diagnosis was 20.0 weeks. The clinical-stage of 93.3% of the patients with CCIP was IB1, 81.9% visited the clinic because of vaginal bleeding during pregnancy, and 72.4% had not been screened for cervical cancer in more than 5 years. To analyze cancer treatments during pregnancy, patients were grouped into two groups, termination of pregnancy (TOP, n = 67) and continuation of pregnancy (COP, n = 38). Analyses suggested that the TOP group was more likely to be diagnosed at an earlier gestational stage than the COP group (14.8 vs. 30.8 weeks, p < 0.001). The unadjusted hazard ratio for the COP group's overall survival was 1.063 times that of the TOP group (95% confidence interval = 0.24, 4.71). There were no significant differences between the TOP and COP groups in maternal survival (p = 0.964). Thirty-three of the infants of patients with CCIP were healthy at the end of the follow-up period, with a median age of 18 ± 2.8 months. Conclusions: Most patients with CCIP had not been screened for cervical cancer in over 5 years. The oncologic outcomes of the TOP and COP groups were similar. A platinum-based neoadjuvant chemotherapy regimen could be a favorable choice for the management of CCIP during the second and third trimesters of pregnancy.
Background: This retrospective multi-center study aimed to describe the epidemiological characteristics, clinical features, and management of patients with cervical cancer in pregnancy (CCIP) and evaluate maternal and infant outcomes. Methods: The data of patients with CCIP were retrospectively collected from those diagnosed and treated in 17 hospitals in 12 provinces in China between January 2009 and November 2017. The information retrieved included patients' age, clinical features of the tumor, medical management (during pregnancy or postpartum), obstetrical indicators (i.e., gestational age at diagnosis, delivery mode, and birth weight), and maternal and neonatal outcomes. Survival analyses were performed using Kaplan-Meier survival curves and log-rank tests that estimated the overall survival of patients. Results: One-hundred and five women diagnosed with CCIP (median age = 35 years) were identified from ~45,600 cervical cancerpatients (0.23%) and 525,000 pregnant women (0.020%). The median gestational age at cancer diagnosis was 20.0 weeks. The clinical-stage of 93.3% of the patients with CCIP was IB1, 81.9% visited the clinic because of vaginal bleeding during pregnancy, and 72.4% had not been screened for cervical cancer in more than 5 years. To analyze cancer treatments during pregnancy, patients were grouped into two groups, termination of pregnancy (TOP, n = 67) and continuation of pregnancy (COP, n = 38). Analyses suggested that the TOP group was more likely to be diagnosed at an earlier gestational stage than the COP group (14.8 vs. 30.8 weeks, p < 0.001). The unadjusted hazard ratio for the COP group's overall survival was 1.063 times that of the TOP group (95% confidence interval = 0.24, 4.71). There were no significant differences between the TOP and COP groups in maternal survival (p = 0.964). Thirty-three of the infants of patients with CCIP were healthy at the end of the follow-up period, with a median age of 18 ± 2.8 months. Conclusions: Most patients with CCIP had not been screened for cervical cancer in over 5 years. The oncologic outcomes of the TOP and COP groups were similar. A platinum-based neoadjuvant chemotherapy regimen could be a favorable choice for the management of CCIP during the second and third trimesters of pregnancy.
Authors: Frédéric Amant; Michael J Halaska; Monica Fumagalli; Karina Dahl Steffensen; Christianne Lok; Kristel Van Calsteren; Sileny N Han; Olivier Mir; Robert Fruscio; Cathérine Uzan; Cynthia Maxwell; Jana Dekrem; Goedele Strauven; Mina Mhallem Gziri; Vesna Kesic; Paul Berveiller; Frank van den Heuvel; Petronella B Ottevanger; Ignace Vergote; Michael Lishner; Philippe Morice; Irena Nulman Journal: Int J Gynecol Cancer Date: 2014-03 Impact factor: 3.437
Authors: F Amant; P Berveiller; I A Boere; E Cardonick; R Fruscio; M Fumagalli; M J Halaska; A Hasenburg; A L V Johansson; M Lambertini; C A R Lok; C Maggen; P Morice; F Peccatori; P Poortmans; K Van Calsteren; T Vandenbroucke; M van Gerwen; M van den Heuvel-Eibrink; F Zagouri; I Zapardiel Journal: Ann Oncol Date: 2019-10-01 Impact factor: 32.976
Authors: Federica Bernardini; Gabriella Ferrandina; Caterina Ricci; Anna Fagotti; Francesco Fanfani; Anna Franca Cavaliere; Benedetta Gui; Giovanni Scambia; Rosa De Vincenzo Journal: Curr Oncol Date: 2022-08-14 Impact factor: 3.109