Management of Cervical Cancer in Pregnant Women: A Multi-Center Retrospective Study in China

Abstract

Background: The diagnosis and management of cervical cancer in pregnant women is a grim fact due to inadequate cervical cancer screening in China. Based on a muti-center collected data from 2009-2017, we aimed to estimate the epidemiology, management, and maternal and infant outcomes of cervical cancer during pregnancy in China. Methods: One hundred and five cases of cervical cancer in pregnancy were collected in 22 central hospitals from 15 provinces during Jan, 2009 to Nov,2017 initiated by Chinese Society for Colposcopy and Cervical Pathology (CSCCP) in China. We requested a listing of individual records of cancer cases, including age, the tumor clinical feature (based on FIGO staging and histopathology), the management of cancer (during pregnancy or postpartum), the obstetrical indicators as gestational age [GA] at diagnosis and delivery, delivery mode, birthweight, 5-minute Apgar scores, and neonatal outcome), and the maternal outcome. We also compared the management of patients who terminated pregnancy (P-tp) and the patients who continued pregnancy (P-cp) and the oncologic and obstetric outcome in China. Findings: A total of 105 women diagnosed with cervical cancer in pregnancy were identified from 45 652 patients of cervical cancer (0.23%, 105/45 652) and 525 000 pregnant women (0.020%, 105/525 000) during the study period. The mean age was 33±5 years old (range, 17-45 years old). 98 (93.3%) of 105 patients diagnosed with cervical cancer during pregnancy were stage IB1 and above at the time of diagnosis. 86 (81.90%) of 105 patients presented at the clinic with vaginal hemorrhage during pregnancy. 76 (72.38%) of 105 patients had never been screened for more than five years by their pregnancies. In all, P-tp group(n= 67) were more likely to be diagnosed earlier in pregnancy compared with P-cp group (n=38) (14.8 vs 30.8 weeks, p<0.0001). Oncologic characters as stage and pathological type in P-cp group were similar to P-tp group. Moreover, there was no maternal survival difference between the two groups (92.5.3% vs 92.1%, p=0.964). Neoadjuvant chemotherapy(NACT) was performed among 31.6% (12/38) of P-cp group, significantly higher than the P-tp group 10.4%(7/67) (p=0.007). Follow-up to 34 P-cps showed that their children are alive healthy. Interpretation: In China, most of the pregnant patients with cervical cancer had not been screened for cervical cancer within five years. The oncologic outcome of P-tp was similar to P-cp , the latter with platinum-based NACT regimen could be effective after the first trimester until fetal maturity, of whose children showed a normal development, no long-term complications were detected. Funding: LMZ are supported by Beijing Natural Science Foundation (7174359) and National key research and development plan (2016YFC1302901) Declaration of Interest: We declare no competing interests. Ethical Approval: The retrospective analysis protocol was reviewed and approved by the Institutional Review Boards of all the hospitals.