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Characteristics of patients with cervical cancer during pregnancy: a multicenter matched cohort study. An initiative from the International Network on Cancer, Infertility and Pregnancy
  1. Michael J Halaska1,
  2. Catherine Uzan2,3,
  3. Sileny N Han4,
  4. Robert Fruscio5,
  5. Karina Dahl Steffensen6,
  6. Ben Van Calster7,
  7. Hana Stankusova8,
  8. Martina Delle Marchette5,
  9. Astrid Mephon9,
  10. Roman Rouzier10,
  11. Petronella O Witteveen11,
  12. Patrizia Vergani5,
  13. Kristina Van Calsteren7,12,
  14. Lukas Rob1 and
  15. Frederic Amant4,13,14
  1. 1Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
  2. 2Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
  3. 3Department of Gynecology and Breast surgery, Pitié Salpêtrière Hospital, Institut Universitaire de Cancérologie, Sorbonne University, INSERM U938, Paris, France
  4. 4Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
  5. 5Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
  6. 6Department of Oncology, Vejle Hospital, Vejle, Denmark
  7. 7Department of Development and Regeneration, KU Leuven, Leuven, Belgium
  8. 8Department of Medical Oncology, Faculty Hospital Motol, 2nd Medical Faculty, Charles University, Prague, Czech Republic
  9. 9Hospital Tenon, Paris, France
  10. 10Institut Curie, Paris, France
  11. 11Department of Medical Oncology, Cancer Center University Medical Center, Utrecht, The Netherlands
  12. 12Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
  13. 13Department of Oncology, KU Leuven, Leuven, Belgium
  14. 14Centre for Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
  1. Correspondence to Frederic Amant, Gynecologic Oncology, University Hospitals Leuven, Leuven 3000, Belgium; frederic.amant{at}uzleuven.be

Abstract

Background Treatment of cervical cancer during pregnancy is often complex and challenging. This study aimed to analyze current patterns of practice in the management of pregnant patients diagnosed with cervical cancer.

Methods This was a matched cohort study comprising patients managed for cervical cancer during pregnancy from six European centers. Patient information was retrieved from the dataset of the International Network for Cancer, Infertility and Pregnancy from 1990 to 2012. Each center matched its patients with two non-pregnant controls for age (±5 years) and International Federation of Gynecology and Obstetrics (FIGO) 2009 stage. Information on age, histological type, grade, lymphovascular space invasion, stage, tumor size, method of diagnosis, site of recurrence, delivery, date of recurrence, and date of death was recorded. Progression-free survival was compared using multivariable Cox proportional hazards regression.

Results A total of 132 pregnant patients and 256 controls were analyzed. The pregnant patients (median age 34 years, range 21–43) were diagnosed at a median gestational age of 18.4 weeks of pregnancy (range 7–39). Stage distribution during pregnancy was 14.4% for stage IA, 47.0% for IB1, 18.9% for IB2, and 19.7% for II-IV. For treatment during pregnancy, 17.4% of the patients underwent surgery, 16.7% received neoadjuvant chemotherapy, 26.5% delayed their treatment, 12.9% had a premature delivery, and 26.5% had their pregnancy terminated. Median follow-up was 84 months (67 months for pregnant and 95 months for non-pregnant patients). The unadjusted hazard ratio of pregnancy for progression-free survival was 1.18 (95% confidence interval 0.74 to 1.88).

Conclusion Surgery and chemotherapy is increasingly used in the management of pregnant patients with cervical cancer and prognosis is similar to that of non-pregnant patients.

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Footnotes

  • Funding FA is senior researcher for the Research Fund Flanders (FWO). FA was supported by CRADLE, European Research Council (consolidator grant no. ZKD0230). MJH was supported by Charles University research project Progres Q28-Oncology and Q34.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned, externally peer reviewed.

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