Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Treatment delays and outcomes in pregnancy-associated cancer: a multicenter analysis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Sarfraz Azza, Woldesenbet Selamawit, Chatzipanagiotou Odysseas P, Altaf Abdullah, Mevawalla Areesh, Khalil Mujtaba, Rashid Zayed, Zindani Shahzaib, Pawlik Timothy M
Аннотация
BACKGROUND: Management of pregnancy-associated cancers (PACs)-malignancies diagnosed during pregnancy or within 1 year postpartum-poses unique clinical challenges. Treatment decisions must balance maternal cancer control with fetal safety, yet little is known about how cancer treatment timing varies between pregnant and nonpregnant individuals or how PACs affect obstetric and neonatal outcomes. Understanding these associations is critical to improve care strategies for this vulnerable population.
METHODS: We conducted a retrospective cohort study using Epic Cosmos, a large multicenter United States electronic health record database. The primary "cancer" cohort included individuals aged 18 to 49 years diagnosed as having cancer between January 2018 and December 2022. These individuals were categorized by pregnancy status at diagnosis: gestational PAC, postpartum PAC, or nonpregnant. A secondary "maternal" cohort comprised individuals with viable deliveries during the same period; gestational PAC pregnancies were matched 1:4 with cancer-unexposed pregnancies. Primary outcomes were time from cancer diagnosis to initiation of surgery, radiotherapy, and chemotherapy. Secondary outcomes included 30-day surgical complications, mortality, readmissions, and obstetric and neonatal outcomes such as cesarean delivery, preterm birth, low birth weight, and 5-min appearance, pulse, grimace, activity, and respiration (Apgar) scores.
RESULTS: Among 38,345 individuals in the cancer cohort (median age, 43 years; IQR, 38-47), most were White (n = 26,594; 71.3%) and married (n = 19,230; 51.5%). Gestational PAC was associated with 15% longer time to surgery (adjusted rate ratio [aRR], 1.15; 95% CI, 1.13-1.17), 28% longer time to radiotherapy (aRR, 1.28; 95% CI, 1.27-1.29), and 29% shorter time to chemotherapy initiation (aRR, 0.71; 95% CI, 0.70-0.72) than nonpregnant controls. Postpartum PAC was associated with 13% shorter time to surgery (aRR, 0.87; 95% CI, 0.86-0.88) and 30% shorter time to chemotherapy (aRR, 0.70; 95% CI, 0.70-0.71). In the maternal cohort, gestational PAC was associated with higher odds of cesarean delivery (adjusted odds ratio [aOR], 1.21; 95% CI, 1.04-1.41), preterm birth (aOR, 3.79; 95% CI, 3.15-4.56), low birth weight (aOR, 3.08; 95% CI, 2.50-3.77), and low 5-min Apgar scores (aOR, 1.86; 95% CI, 1.20-2.82).
CONCLUSION: PAC was associated with delays in locoregional treatment and increased maternal and neonatal morbidity, underscoring the need for coordinated multidisciplinary care to optimize outcomes for women with PACs.
METHODS: We conducted a retrospective cohort study using Epic Cosmos, a large multicenter United States electronic health record database. The primary "cancer" cohort included individuals aged 18 to 49 years diagnosed as having cancer between January 2018 and December 2022. These individuals were categorized by pregnancy status at diagnosis: gestational PAC, postpartum PAC, or nonpregnant. A secondary "maternal" cohort comprised individuals with viable deliveries during the same period; gestational PAC pregnancies were matched 1:4 with cancer-unexposed pregnancies. Primary outcomes were time from cancer diagnosis to initiation of surgery, radiotherapy, and chemotherapy. Secondary outcomes included 30-day surgical complications, mortality, readmissions, and obstetric and neonatal outcomes such as cesarean delivery, preterm birth, low birth weight, and 5-min appearance, pulse, grimace, activity, and respiration (Apgar) scores.
RESULTS: Among 38,345 individuals in the cancer cohort (median age, 43 years; IQR, 38-47), most were White (n = 26,594; 71.3%) and married (n = 19,230; 51.5%). Gestational PAC was associated with 15% longer time to surgery (adjusted rate ratio [aRR], 1.15; 95% CI, 1.13-1.17), 28% longer time to radiotherapy (aRR, 1.28; 95% CI, 1.27-1.29), and 29% shorter time to chemotherapy initiation (aRR, 0.71; 95% CI, 0.70-0.72) than nonpregnant controls. Postpartum PAC was associated with 13% shorter time to surgery (aRR, 0.87; 95% CI, 0.86-0.88) and 30% shorter time to chemotherapy (aRR, 0.70; 95% CI, 0.70-0.71). In the maternal cohort, gestational PAC was associated with higher odds of cesarean delivery (adjusted odds ratio [aOR], 1.21; 95% CI, 1.04-1.41), preterm birth (aOR, 3.79; 95% CI, 3.15-4.56), low birth weight (aOR, 3.08; 95% CI, 2.50-3.77), and low 5-min Apgar scores (aOR, 1.86; 95% CI, 1.20-2.82).
CONCLUSION: PAC was associated with delays in locoregional treatment and increased maternal and neonatal morbidity, underscoring the need for coordinated multidisciplinary care to optimize outcomes for women with PACs.