A Retrospective Study And Literature Analysis Of Cervical Cancer In Pregnancy

Objective:Although cervical cancer in pregnancy(CCIP)is the most common malignant tumor of the female reproductive system during pregnancy,it is still very rare.The purpose of this study is to analyze the risk factors influencing the prognosis of CCIP patients and explore the effective management and treatment through a retrospective study.Methods:A total of 50 CCIP patients admitted to Qilu Hospital of Shandong University from January 1,2010 to December 31,2021 were collected.Relevant literatures published from 2010 to 2021 were searched on PUBMED,and another 58 CCIP patients were included.The clinical characteristics,pathological features and treatment methods of 108 CCIP patients were summarized,and the risk factors affecting their prognosis were analyzed through the retrospective study.Results:1.The mean age of CCIP patients at the time of diagnosis was 32.57 ± 4.59(19-45)years.Among these patients,56 patients had abnormal vaginal bleeding or discharge,and 52 patients had no obvious symptoms.There were 9 patients in stage ⅠA,69 patients in stage ⅠB,4 patients in stage ⅡA,3 patients in stage ⅡB and 23 patients in stage Ⅲ.There were 70 patients with squamous cell carcinoma(SC),22 patients with adenocarcinoma(AC),5 patients with adenosquamous carcinoma(ASC)and 11 patients with other pathological types.2.Among the 85 patients diagnosed before delivery,26 patients chose termination of pregnancy(TOP),59 patients chose continuation of pregnancy(COP).There were 37 patients in the COP group received neoadjuvant chemotherapy(NACT)before delivery,including 22 patients receiving combination chemotherapy and 15 patients receiving single drug chemotherapy.A total of 11 patients in the NACT group had staging decline and/or tumor shrinkage.There is a statistical difference in objective response rate(ORR)between combination chemotherapy and single drug chemotherapy,but there is no statistical difference in prognosis between the two groups.NACT is associated with preterm birth,but not with low birth weight or other systemic complications.3.By the end of follow-up,a total of 19 patients had recurrence or metastasis,of which 4 patients survived and 15 patients died.Univariate analysis shows that age,tumor differentiation,tumor diameter,pathological type,lymphovascular space invasion(LVSI),lymph node metastasis,the depth of cervical interstitial invasion,International Federation of Gynecology and Obstetrics(FIGO)staging in 2018 and adjuvant therapy after the end of pregnancy have significant influence on prognosis,while previous delivery history,time of diagnosis,mode of delivery,pregnancy reservation and NACT have no significant influence on prognosis.When age,tumor differentiation,tumor diameter,pathological type,LVSI,lymph node metastasis,the depth of cervical interstitial invasion,stage and adjuvant therapy after the end of pregnancy are included in the multivariate analysis of CCIP patients,adjuvant therapy after the end of pregnancy has no significant effect on prognosis.When pathological type,lymph node metastasis,stage and pregnancy reservation are included in the multivariate analysis of patients diagnosed before delivery,pregnancy reservation has no significant effect on prognosis.When stage,gestational age at diagnosis and NACT are included in the multivariate analysis of COP patients with gestational age<35 weeks at diagnosis,NACT has no significant effect on prognosis.Conclusion:Age,tumor differentiation,tumor diameter,pathological type,LVSI,lymph node metastasis,the depth of cervical interstitial invasion and stage are risk factors for prognosis of CCIP patients.Pregnancy reservation,NACT and adjuvant therapy after the end of pregnancy have no significant effect on the prognosis.Although NACT does not significantly improve the prognosis of COP patients,it is a worthwhile option to reduce stage and/or shrink tumor.