妊娠期恶性肿瘤孕产妇和新生儿结局的前瞻性队列研究

Maternal and pediatric outcome after maternal cancer diagnosed during pregnancy : A cohort study

目的评估妊娠期恶性肿瘤孕产妇和新生儿结局。方法多中心前瞻性队列研究。以第三军医大学3所附属医院作为队列研究现场,收集妊娠期病理诊断为恶性肿瘤且继续妊娠的连续病例(病例组),所在医院每个病例以相同匹配条件并按照1∶1匹配建立对照组,截取两组孕产妇和新生儿信息,考察临床特征和母子结局,考察病例组化疗干预对病死率和存活儿童发育(年龄与发育进程问卷Ⅲ,ASQⅢ)的影响因素。结果 2012至2016年3中心80 524例孕妇进入本文分析,83例(1.03‰)孕妇在妊娠期诊断恶性肿瘤,2012年0.45‰至2016年1.28‰;截止至2017年9月1日35/83例(42.2%)死亡,排前5位肿瘤疾病占72.3%(60/83):白血病26例,甲状腺癌和宫颈癌各10例,恶性卵巢瘤8例,乳腺癌6例;24名妊娠期恶性肿瘤的孕妇于妊娠28周前终止妊娠,8例平均在诊断恶性肿瘤后的(37.0±20.0)个月死亡;妊娠期恶性肿瘤继续妊娠59例行对照组1∶1匹配,继续妊娠59例中死亡27例(47.4%),其中10例在孕中、晚期给予化疗,死亡1例(10.0%),均未发生化疗相关的新生儿畸形。49例妊娠期恶性肿瘤孕妇未行化疗死亡26例(53.1%),化疗亚组与非化疗亚组,孕妇病死率差异有统计学意义(P=0.016)。病例组与对照组比较、化疗亚组与非化疗亚组比较,ASQⅢ差异均无统计学意义(P均=1.00)。结论妊娠期化疗可降低孕产妇死亡率,但并不影响儿童病死率和生长发育。

Objective To evaluate maternal and pediatric outcome after maternal cancer diagnosed during pregnancy.Methods This was a prospective, multicenter cohort study conducted in the 3 affiliated hospital of Third Military MedicalUniversity. Inclusion criteria were women pathologically diagnosed with cancer during pregnancy （ case group）, each controlchildren must meet the same conditions and were matched in a 1 ∶ 1 ratio （ control group）. Maternal and pediatric informations oftwo groups were collected , in order to investigate the clinical characteristics and maternal and child outcome, as well as the factorsof chemotherapy intervention in case group on mortality and the Ages and Stages Questionnaires3（ASQ Ⅲ） of survival children.Results A total of 80,524 pregnant women from 2012 to 2016 were screened, Of whom 83（1.03‰） were diagnosed with cancerduring pregnancy. The morbidity rate of women with cancer was 0.45‰ in 2012 and 1.28‰ in 2016 increased year by year. Deathoccurred in 42. 2% （ 35 / 83） women during follow up to September 2017. The top 4 cancers were leukemia 26 cases, thyroidcarcinoma 10 cases, cervical carcinoma 10 cases, and oophoroma cancer 8 cases. During pregnancy, 24 women terminatedpregnancy before 28 weeks and among them 8（ 33.3%） died on average （ 37.0± 20.0） months after the diagnosis of cancer. 59women continued pregnancy were included and 59 neonates were matched in a 1 ∶ 1 ratio as controls. Death occurred in 47.4%（27 / 59） ,and 10 women received chemotherapy during the second and third trimesters. There was 1 case （ 10%） died and nochemotherapyassociated neonatal malformations. Death occurred in 53. 1% （ 26 / 49） women without chemotherapy. Women whoreceived chemotherapy had a statistically significant lower mortality rate when compared to the nontreatment group（P = 0.336）.However, The ASQ Ⅲ assessment was not different between case group and control group as well as chemotherapy subgroup andnon chemotherapy subgroup. Conclusion Chemotherapy can reduce the mortality of women diagnosed with cancer during pregnancy, without affecting the mortality of children and ASQ Ⅲ？associated development.