Cause-Specific Survival for Women Diagnosed With Cancer During Pregnancy or Lactation: A Registry-Based Cohort Study
Cause-Specific Survival for Women Diagnosed With Cancer During Pregnancy or Lactation: A Registry-Based Cohort Study
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DOI：
10.1200/jco.2008.17.4110
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发表时间：
2009-01-01
影响因子：
45.3
通讯作者：
Fossa, Sophie D.
中科院分区：
文献类型：
--
作者：
Stensheim, Hanne;Moller, Bjorn;Fossa, Sophie D.
目的评估孕期或哺乳期确诊的癌症是否与特定原因死亡风险的增加有关。在这项基于人群的队列研究中，患者和方法利用挪威癌症登记处和医学出生登记处的数据，选择了42511名年龄在16岁至49岁之间、1967年至2002年被诊断为癌症的妇女作为研究对象。诊断时，他们被分成未怀孕(参考)、怀孕或哺乳期。使用COX比例风险模型对所有部位合并和最常见的恶性肿瘤的特定原因生存率进行了调查。对有和没有癌症后怀孕的妇女进行了另一项与时间相关的协变量分析。结果所有地点的死因死亡无统计学差异，妊娠组和哺乳组的危险比(HR)分别为1.03(95%CI，0.86~1.22)和1.02(95%CI，0.86~1.22)。在哺乳期诊断为乳腺癌(HR，1.95；95%CI，1.36至2.78)和卵巢癌(HR，2.23；95%CI，1.05至4.73)的患者有更高的死因死亡风险。妊娠期诊断为恶性黑色素瘤略微增加了这种风险。在所有的部位加在一起，癌症后怀孕的女性的特定原因死亡的风险显著降低。结论总的来说，大多数癌症类型在怀孕或哺乳期间的诊断不会增加特定原因死亡的风险。哺乳期确诊的乳腺癌和卵巢癌是个例外。我们证实了癌症后怀孕妇女的“健康母亲效应”。
Purpose To assess if cancers diagnosed during pregnancy or lactation are associated with increased risk of cause-specific death.Patients and Methods In this population-based cohort study using data from the Cancer Registry and the Medical Birth Registry of Norway, 42,511 women, age 16 to 49 years and diagnosed with cancer from 1967 to 2002, were eligible. They were grouped as not pregnant ( reference), pregnant, or lactating at diagnosis. Cause-specific survival for all sites combined, and for the most frequent malignancies, was investigated using a Cox proportional hazards model. An additional analysis with time-dependent covariates was performed for comparison of women with and without a postcancer pregnancy. The multivariate analyses were adjusted for age at diagnosis, extent of disease, and diagnostic periods.Results For all sites combined, no intergroup differences in cause-specific death were seen, with hazard ratio (HR) of 1.03 (95% CI, 0.86 to 1.22) and HR 1.02 ( 95% CI, 0.86 to 1.22) for the pregnant and lactating groups, respectively. Patients with breast ( HR, 1.95; 95% CI, 1.36 to 2.78) and ovarian cancer (HR, 2.23; 95% CI, 1.05 to 4.73) diagnosed during lactation had an increased risk of cause-specific death. Diagnosis of malignant melanoma during pregnancy slightly increased this risk. For all sites combined, the risk of cause-specific death was significantly decreased for women who had postcancer pregnancies.Conclusion In general, the diagnosis of most cancer types during pregnancy or lactation does not increase the risk of cause-specific death. Breast and ovarian cancer diagnosed during lactation represents an exception. We confirmed the "healthy mother effect" for women with a postcancer pregnancy.