Clinical Analysis Of 37 Cases Of Cervical Cancer Associated With Pregnancy

Objective:This study aims to analyze the clinico-pathologic characteristics and prognostic factors in patients with pregnancy complicated with cervical cancer,and explore the best clinical management methods for pregnancy with cervical cancer.Methods:The clinicopathological data of 37 pregnant women with cervical cancer admitted from January 2012 to November 2017 in Qilu Hospital of Shandong University were retrospectively analyzed.The clinical and pathological features of patients with cervical cancer in different pregnancy periods were analyzed,as well as the terminate way of the pregnancy,treatment options and follow-up.Kaplan-Meier method was used for survival analysis.The single factors that affected the prognosis were analyzed by log-rank test.The influence of clinicopathological factors on the prognosis of cervical cancer in pregnancy was discussed.Restults:Of the 37 patients,5 cases were in the first trimester(14%),6 cases were during the second trimester(16%),6 cases were during the third trimester(16%),and 20 cases were in the postpartum period(54%).Patients diagnosed in the first trimester(5 to 12 weeks of gestation)terminated the pregnancy and began tumor treatment as soon as possible.Patients diagnosed in the second trimester of pregnancy(17 to 27 weeks of gestation)gave up pregnancy and started cervical cancer treatment,except one patient.One patient of 18 weeks pregnancy with stage ?B cervical cancer was treated with neoadjuvant chemotherapy for 3 cycles to 32 weeks pregnancy.Then she underwent caesarean section and radical abdominal hysterectermy at the same time,and was given chemotherapy after surgery.Patients diagnosed in the third trimester(32 to 39 weeks of gestation)were treated with cesarean section to terminate the pregnancy after diagnosis,and 3 patients of them underwent radical abdominal hysterectermy in the meantime.6 neonates were delivered,5 survived and 1 died.Three patients only underwent caesarean section.The patients diagnosed within 6 months after delivery include 12 case through caesarean section delivery,7 cases through vaginal delivery,and 1 case through induction delivery because of fetal anomaly.Among the 37 patients,there were no cases of lost follow-up,26 cases survived without tumor,10 cases died due to disease progression,and 1 case was relapsed.Univariate analysis suggested that tumor size,depth of interstitial invasion,lymph node metastasis,vascular invasion,pathological type,and recurrence were the main factors affecting the prognosis of patients(P<0.05).Conclusions:The clinical symptoms of pregnant women with cervical cancer are easily confused with some related symptoms in obstetrics.Underscore the screening of cervical cancer before pregnancy and the routine gynecological examination of vaginal bleeding during pregnancy.Gestational age at diagnosis is an important determinant of management of cervical cancer in pregnancy.Women who died were more likely to have advanced stage disease at the time of diagnosis or seek treatment inactively.According to the patient's gestational age,stage of tumor,and willingness to continue pregnancy,a highly individualized treatment plan should be developed to obtain a good mother-child outcome.Patients with locally advanced and advanced cervical cancer who strongly desire to preserve the fetus can choose to undergo preoperative chemotherapy to extend the gestational age to the fetus with survivability.This is worth further research.