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The Prognosis of Cervical Cancer Associated With Pregnancy: A Matched Cohort Study

VANGE, N. VANDER; WEVERLING, G. J.; KETTING, B. W.; ANKUM, W. M.; SAMLAL, R.; LAMMES, F. B.
Obstetrics & Gynecology: June 1995
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Objective To assess the effect of pregnancy on the prognosis of cervical cancer and the morbidity of standard treatment.

Methods We analyzed 44 women with cervical carcinoma associated with pregnancy, who were matched with 44 controls. Matching criteria were age, stage of disease (according to the International Federation of Gynecology and Obstetrics classification), tumor type, treatment modality, and period of treatment.

Results In 23 cases, cervical cancer was diagnosed during pregnancy and in the other 21 cases, within 6 months after delivery. Thirty-nine women had early-stage disease (eight IA, 25 IB, and six IIA), and five had advanced stages (four IIB and one IIIB). The overall 5-year survival rate was 80% among subjects and 82% among controls, whereas the relative risk (RR) of dying within 5 years was 1.12 (95% confidence interval [CI] 0.48–2.65). With regard to the 5-year survival rate (85% for both subjects and controls, the RR of dying was 1.00 [95% CI 0.35–2.83]); no differences were found between subjects and controls for early-stage cervical carcinoma. The size of the group with advanced-stage cervical carcinoma was too small to allow any statistical analysis. No statistically significant differences in survival were observed between cases diagnosed during pregnancy and cases diagnosed after delivery. In addition, the mode of delivery had no effect on survival. Early complications within 6 weeks after treatment were seen 33 times in 25 subjects and 29 times in 23 controls. No differences were observed in the prevalence and type of early complications in subjects versus controls. Late complications after 6 weeks of treatment were seen nine times in nine subjects and 11 times in ten controls. No significant differences were observed in the prevalence and type of late complications in subjects versus controls.

Conclusion The prognosis of early-stage cervical cancer is similar in pregnant and nonpregnant patients when standard treatment is given. Because of the limited number of patients, no conclusions can be drawn about advanced-stage cervical cancer. The goal should be standard oncologic treatment, which does not lead to morbidity in pregant patient.

Address reprint requests to: N. Van der Vange, MD, PhD Department of Gynecology (H4N) Academic Medical Center University of Amsterdam P.O. Box 22700 Amsterdam 1100 DE The Netherlands.

© 1995 The American College of Obstetricians and Gynecologists