Trends in pregnancy-associated cervical cancer in Japan between 2012 and 2017: A multicenter survey

Abstract

AbstractLarge-scale data on maternal and neonatal outcomes of pregnancy-associated cervical cancer in Japan are scarce, and treatment strategies have not been established. We conducted this multicenter retrospective observational study at 523 secondary/tertiary care hospitals in Japan to investigate the clinical features and trends in pregnancy-related cervical cancer treatments. We collected data for 290 patients with pregnancy-associated cervical cancer (during pregnancy, n=203; postpartum, n=87) diagnosed between January 1, 2012, and December 31, 2017. Of the 40 patients diagnosed at ≥22 gestational weeks, 34 (85.0%) were carefully followed until delivery without intervention. Of the 163 patients diagnosed at <22 gestational weeks, 111 and 52 patients continued and terminated their pregnancies, respectively. Although the termination rate increased with cervical cancer stage, 90 patients with stage IB1 disease had a variety of treatment options, including termination of pregnancy. When we divided the 59 stage IB1 patients who continued their pregnancy into four groups based on the primary treatment (strict follow-up, conization, trachelectomy, and neoadjuvant chemotherapy), there were no significant differences in progression-free or overall survival. The percentile of birth weight at delivery was smaller in the neoadjuvant chemotherapy group than in the strict follow-up group (P =.02). The full-term delivery rate was relatively higher in the trachelectomy group (35%) than in the other groups. In conclusion, treatment decisions, including pregnancy termination for pregnancy-associated cervical cancer, should be made after estimating the stage, with careful consideration of both maternal and fetal benefits. These findings will help in developing treatment guidelines for pregnancy-associated cervical cancer.