Adnexal masses in pregnancy: How often are they malignant?
Adnexal masses in pregnancy: How often are they malignant?
复制标题
DOI：
10.1016/j.ygyno.2005.10.022
复制
发表时间：
2006-05-01
影响因子：
4.7
通讯作者：
Smith, LH
中科院分区：
文献类型：
--
作者：
Leiserowitz, GS;Xing, GB;Smith, LH
目标。主要目的是调查1991年至1999年在加州三个大型数据库中发现的与怀孕有关的良性和恶性卵巢肿瘤的发生率。第二个目标是确定这些孕妇的母亲和围产儿结局。这是一项基于人群的研究，使用1991年至1999年加州医院的出院记录，对4846,505名产科患者进行了研究。加州生命统计出生/病人出院数据库与加州癌症登记处(CCR)相连。根据诊断和怀孕的时间将母亲卵巢癌和低恶性潜能(LMP)肿瘤分为三个时期：产前、分娩和产后。使用国际疾病分类第9版(ICD-9)编码来确定住院期间发生的诊断和程序因素。CCR数据库用于识别癌症预后，如分期、组织学、治疗和生命状态。9375名妇女被医院诊断为与怀孕有关的卵巢肿块。CCR数据库在同一队列中发现了87例卵巢癌和115例LMP肿瘤。卵巢癌的发生率为0.93%(87/9375)，每千例分娩中卵巢癌的发生率为0.0179/1000。卵巢癌和LMP肿瘤的概要分期分别为：局限性65.5%和81.7%，区域性6.9%和7.8%，远处23.0%和4.4%，不明4.6%和6.1%。87例卵巢癌中34例为生殖细胞肿瘤(GCT)。与非癌症孕妇对照组相比，卵巢恶性肿瘤增加了产妇结局的可能性，如剖腹产、子宫切除、输血和延长住院时间，但不会对新生儿结局产生不利影响。随访的孕产妇死亡率为4.7%(9/191)，平均为2.43年。卵巢恶性肿瘤在怀孕期间很少见。大多数母体恶性卵巢肿瘤都是早期的，并与良好的母体和新生儿预后相关。孕产妇死亡率低可能是由于GCTS在卵巢癌中占主导地位。(C)2005 Elsevier Inc.保留所有权利。
Objective. The primary objective was to investigate the occurrence rates of benign and malignant ovarian tumors associated with pregnancy among women identified in three large California databases between 1991 and 1999. The secondary objective was to determine maternal and perinatal outcomes among these pregnancies.Methods. This is a population-based study of 4,846,505 obstetrical patients using California hospital discharge records from 1991-1999. The California vital statistics birth/patient discharge database was linked to the California Cancer Registry (CCR). Cases of maternal ovarian cancers and low malignant potential (LMP) tumors were separated into three periods based on the timing of diagnosis and pregnancy: prenatal, at delivery, and postpartum. International Classification of Diseases, Revision 9 (ICD-9) codes were used to identify both diagnostic and procedural factors occurring during hospitalizations. The CCR database was used to identify cancer outcomes such as stage, histology, treatments, and vital status.Results. 9375 women had a hospital diagnosis of an ovarian mass associated with pregnancy. CCR database identified 87 ovarian cancers and 115 LMP tumors in the same cohort. The occurrence rates were 0.93% (87/9375) ovarian cancers per total number of ovarian masses diagnosed during pregnancy, and 0.0179 ovarian cancers per 1000 deliveries. The summary stages of the ovarian cancers and LMP tumors were (respectively): localized 65.5% and 81.7%, regional 6.9% and 7.8%, remote 23.0% and 4.4%, and unknown 4.6% and 6.1%. 34 of the 87 ovarian cancers were germ cell tumors (GCT). Malignant ovarian tumors increased the likelihood of maternal outcomes such as cesarean delivery, hysterectomy, blood transfusions, and prolonged hospitalization compared to noncancer pregnant controls, but did not adversely affect neonatal outcomes. Cause-specific maternal mortality of patients with follow-up was 4.7% (9/191) at a mean of 2.43 years after diagnosis.Conclusions. Ovarian malignancies are rare during pregnancy. Most maternal malignant ovarian neoplasms are early stage and associated with favorable maternal and neonatal outcomes. The low maternal mortality rate is likely due to the predominance of GCTs among the ovarian cancers. (c) 2005 Elsevier Inc. All rights reserved.