Clinical subtypes and prognosis of pregnancy-associated breast cancer: results from the Korean Breast Cancer Society Registry database.

PURPOSE: We analyzed the clinicopathologic characteristics and prognosis of pregnancy-associated breast cancer (PABC) according to clinical subtypes to better understand the characteristics of PABC. METHODS: A total of 83,792 female patients between the ages of 20 and 49 were enrolled in the Korean Breast Cancer Society Registry database from January 1, 1996 to December 31, 2015. 'PABC' is defined as breast cancer diagnosed during pregnancy or within 1 year after delivery. Other patients were defined as 'non-PABC' patients. RESULTS: In non-PABC patients, luminal A subtype was the most common (50.2%). In PABC patients, TNBC was the most common (40.4%) subtype, while luminal A comprised 21.2% and HER2 subtype comprised 17.3%. There was a significant difference in overall survival (OS). In non-PABC patients, TNBC had the highest HR (HR 2.3, 95% CI 2.1-2.6). In PABC patients, the luminal B subtype (HR+ HER2-high Ki67) had the highest HR at 7.0 (95% CI 1.7-29.1). In multivariate analysis of OS by subtypes, PABC patients had significantly higher HR than non-PABC patients in the HER2 subtype (HR 2.0, 95% CI 1.1-3.7) and luminal B subtype (HR+ HER2-high Ki67) (HR 4.4, 95% CI 1.6-12.3). CONCLUSION: PABC showed different biologic features than non-PABC. PABC had a particularly poor prognosis in the luminal B (HR+ HER2-highKi67) and HER2 subtypes. To improve the prognosis of PABC, treatment should be considered according to subtype. Development of drugs that can be used during pregnancy is needed.

Using hospital discharge data to identify incident pregnancy-associated cancers: a validation study.

BACKGROUND: Pregnancy-associated cancer is associated with maternal morbidities and adverse pregnancy outcomes, and is reported to be increasing. Hospital discharge data have the potential to provide timely information on cancer incidence, which is central to evaluation and improvement of clinical care for women. This study aimed to assess the validity of hospital data for identifying incident pregnancy-associated cancers compared with incident cancers from an Australian population-based statutory cancer registry. METHODS: Birth data from 2001-2008, comprised 470,277 women with 679,736 maternities, were linked to cancer registry and hospitalisation records to identify newly diagnosed cancers during pregnancy or within 12 months of delivery. Two hospital-identified cancer groups were examined; "index cancer hospitalisation" - first cancer admission per woman per pregnancy and "all cancer hospitalisations" -the total number of hospitalisations with a cancer diagnosis and women could have multiple hospitalisations during pregnancy. The latter replicates a scenario where identification of individuals is not possible and hospitalisations are used as the unit of analysis. RESULTS: The incidence of pregnancy-associated cancer (according to cancer registry) was 145.4/100,000 maternities. Incidence of cancer was substantially over-estimated when using hospitalisations as the unit of analysis (incidence rate ratio, IRR 1.7) and under-estimated when using the individual (IRR 0.8). Overall, the sensitivity of "index cancer hospitalisation" was 60.4%, positive predictive value (PPV) 77.7%, specificity and negative predictive value both 100%. Melanoma ascertainment was only 36.1% and breast cancer 62.9%. For other common cancers sensitivities ranged from 72.1% to 78.6% and PPVs 56.4% to 87.3%. CONCLUSION: Although hospital data provide another timely source of cancer identification, the validity is insufficient to obtain cancer incidence estimates for the obstetric population.

Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer.

Previous studies report conflicting data on outcomes of pregnancy-associated breast cancer (PABC). Our aim was to examine the effect of a postpartum diagnosis on maternal prognosis in a young women's breast cancer cohort. We conducted a retrospective cohort study of women age ≤45 years, diagnosed with breast cancer (n = 619) during 1981-2011 at the University of Colorado Hospital and The Shaw Cancer Center in Edwards, CO. Breast cancer cases were grouped according to time between giving birth and diagnosis: nulliparous (n = 125), pregnant (n = 24), < 5 years postpartum (n = 136), >5-<10 postpartum (n = 130), and ≥10 years postpartum (n = 147), to examine the clinicopathologic features and the risk of distance recurrence and death. Cases diagnosed after pregnancy, but within five-years postpartum, had an approximate three fold increased risk of distant recurrence (HR 2.80, 95 % CI: 1.12-6.57) and death (HR 2.65, 95 % CI: 1.09-6.42) compared to nulliparous cases. Postpartum cases diagnosed within five years of last childbirth demonstrated a higher five-year distant recurrence probability (31.1 %) and a markedly lower five-year overall survival probability (65.8 %) compared to nulliparous cases (14.8 and 98.0 %, respectively). A diagnosis of breast cancer during the first five-years postpartum confers poorer maternal prognoses after adjustment for biologic subtype, stage, and year of diagnosis. We propose that the definition of PABC should include cases diagnosed up to at least five-years postpartum to better delineate the increased risk imparted by a postpartum diagnosis. Based on emerging preclinical and epidemiologic data, we propose that pregnant and postpartum cases be researched as distinct subsets of PABC to clarify the risk imparted by pregnancy and the events subsequent to pregnancy, such as breast involution, on breast cancer. Further, we highlight the importance of postpartum breast cancer as an area for further research to reduce the increased metastatic potential and mortality of PABC.

Cancer with pregnancy in a cancer hospital.

BACKGROUND: Cancer during pregnancy is rare, occurring one in every 1,000 pregnancies. Cancer itself rarely harms the baby and some cancer treatments are safe during pregnancy. However, treatment dilemmas often occur. METHODS: Descriptive study was conducted at B. P. Koirala memorial cancer hospital. Case records of women with cancer and pregnancy from January 2001 to February 2012 were analyzed regarding their clinical details, treatment, follow-up and feto-maternal outcome. RESULTS: Nineteen women, of 17 to 40 years had cancer with pregnancy. Observed cancers with pregnancy were: leukemia (4), head and neck (3), ovary (3), cervix (2), rectum (2), breast (1), Non-Hodgkin's lymphoma (1), osteosarcoma (1), spinal cord (1) and vulva (1). Seven women (36%) presented in the second trimester and six women (32%) presented in the first and third trimester each. Seven (36%) women opted for termination of pregnancy for definitive treatment, five (26%) deferred treatment until delivery. Among the seven (36%) that accepted definitive treatment along with pregnancy, fetal demise occurred in three and delivery of healthy baby occurred in four. Nine babies born to mothers with cancer during pregnancy till date have normal growth and development. Total 10 (52%) of the mothers are in remission, six (32%) have died from disease. CONCLUSIONS: Cancers during pregnancy, more common in younger women, posed treatment challenges. Definitive cancer treatment could have greater fetal risk during the first trimester but could be offered with more acceptable risk in the second and third trimesters.

Treatment of gestational trophoblastic neoplasia according to the FIGO 2000 staging and scoring system: a 20 years' experience.

OBJECTIVE: To reassess the efficacy of the Federation of Gynecology and Obstetrics (FIGO) 2000 staging and risk factor scoring system in comparison to the original World Health Organization (WHO) prognostic scoring system (1983) in a single-institute setting. DESIGN: Retrospective review of the medical records of 89 patients with gestational trophoblastic neoplasia. SETTING: Mackay Memorial Hospital, Taipei, a regional referral center for northern Taiwan, over a 20-year period. METHODS: All selected patients were classified retrospectively by the original WHO prognostic scoring system (1983) and the FIGO 2000 system. MAIN OUTCOME MEASURE: Efficacy as the correlation of risk categorization by percentage of patients between the original WHO scoring system (1983) and the FIGO 2000 system. RESULTS: The correlation was 97%. Only two patients were classified as middle risk group in the original WHO system (1983), but as high-risk group by the FIGO 2000 system. CONCLUSION: There was good correlation between the original WHO (1983) and FIGO 2000 systems. Treatment outcomes by FIGO 2000 system were somewhat better than by the original WHO classification.

Teratomas of the ovary: a clinico-pathological evaluation of 87 patients from one institution during a 10-year period.

AIM: To present the classification and diagnostic problems encountered between teratomas and other ovarian tumors as well as with other benign entities diagnosed and treated in our institution. METHODS: We analysed retrospectively the clinical and pathological characteristics of 87 teratomas examined in our hospital during the last ten years. RESULTS: Teratomas constituted 5% of all ovarian tumors. The age range was from 11-69 years old (median: 35). The most frequent symptom was lower abdominal pain in 68% of patients. A pelvic mass was noted in 3% of cases. A pregnancy was present in 3% of patients. In ten cases the tumors were bilateral. Tumor size ranged from 1-16 cm in diameter (median: 7.17 cm). The treatment consisted of cystectomy in 66% of the cases, oophorectomy in 23% or hysterectomy with both adnexa in 11% of cases. Fifty-seven cases presented with a histological diagnosis of mature teratoma, biphasic or triphasic type, three cases with monodermal teratoma, ten cases with ovarian neoplasms of mixed type, 15 cases with epidermal cysts, and two cases with benign cysts. Malignant changes within the teratomas were seen in 5% cases. CONCLUSION: Teratomas are common ovarian tumors at any age, especially during the reproductive age, with a low rate of complications and malignant transformation. The treatment should be based on patient age, fertility status, tumor size, the cystic or solid nature of the tumor and bilaterality.

Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients.

BACKGROUND: Anthracyclines are essential for the treatment of malignancies observed in pregnant patients. Knowledge of the potential side-effects of chemotherapy on the developing fetus is essential for patient counseling. PATIENTS AND METHODS: We collected information concerning patients treated with anthracyclines during pregnancy from a review of literature between 1976 and 2001 and our experience. The events analyzed were malformations, fetal death and spontaneous abortion. A chi(2) test with a Yates correction was used to compare the distribution of severe events. RESULTS: A total of 160 patient pregnancies were analyzed. The fetal outcome was frequently normal (73%). Abnormalities included malformations (3%), fetal death (9%), spontaneous abortion (3%), fetal complications (8%) and prematurity (6%). Fetal death was often directly consecutive to maternal death (40%). Unfavorable fetal outcome was significantly more frequent in leukemia patients (P = 0.001). In patients with solid tumors, the first trimester was significantly associated with more complications (P = 0.029). The risk of severe fetal toxicity was increased 30-fold when the dose of doxorubicin per cycle exceeded 70 mg/m(2) (P = 0.037). CONCLUSIONS: Anthracyclines may induce embryo-fetal toxicity. Nevertheless the risk seems low, especially after the first trimester and using doses of doxorubicin below 70 mg/m(2).

Fibrolamellar carcinoma of the liver in pregnancy. A case report.

Fibrolamellar carcinoma of the liver is a rare tumor that has not been previously reported to occur during pregnancy. A 22-year-old, pregnant Arab woman with documented fibrolamellar carcinoma of the liver was followed at our high-risk pregnancy unit. Despite the severity of the disease, the pregnancy and delivery were uneventful.

Clinicostatistical study of ovarian tumors of germ cell origin.

Ovarian tumors of germ cell origin consisted of 440 dermoid cysts, 5 struma ovariis, 3 immature teratomas (G1, G2), 2 carcinoids, 8 dysgerminoma, 3 yolk sac tumors, one choriocarcinoma, 4 dermoid cysts with malignant transformation, and one immature teratoma (G3) of a total of 1,387 ovarian tumors. The patients' mean ages ranged between 17.3 years to 31.9 years, but the mean ages of those with carcinoid and dermoid cyst with malignant transformation were 46.0 and 53.0 years, respectively. In dermoid cyst bilaterality was 17.3% and occurrence during pregnancy or puerperium was 19.6%. In benign tumors, torsion of pedicle and association with pregnancy or puerperium were frequent unlike common epithelial carcinoma, but ascites was rare. Abdominal tumor, pain and metromenorrphagia were the main symptoms, but abdominal distension was scarce with dermoid cysts. The rate of malignant transformation of dermoid cysts was 0.9% overall but 4.3% in patients over 40 years. The prognosis for borderline germ cell tumors was good.

[Nasopharyngeal cancer and pregnancy. Review of the literature. Report of a case]. / Cancer du cavum et grossesse. Revue de la littérature. A propos d'un cas.

We present a case of a rare condition of nasopharyngeal cancer and pregnancy occurring together. We review the unusual epidemiological, clinical and prognostic features of this type of cancer. Because of the immunological changes that occur in pregnancy and because of the potential oncogenic role of Epstein Barr virus we consider that pregnancy worsens the prognosis for nasopharyngeal cancer. After having pointed out the risks of radiotherapy and particularly of chemotherapy in pregnancy, we discuss the need to carry out a therapeutic abortion because of the effect that pregnancy will have if it is allowed to go on to term.