The prognosis of cervical cancer associated with pregnancy: a matched cohort study.

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 increased morbidity in pregnant patients.

Treatment of interstitial pregnancy with methotrexate: report of an unsuccessful case.

Until now, the traditional management of interstitial pregnancy has been surgical. Lately, we have advocated conservative treatment with methotrexate as an option for infertility patients. This is the first publication of a rupture with abundant intra-abdominal bleeding during systemic treatment with methotrexate of a patient with an interstitial pregnancy. Signs of therapy failure are discussed.

Carcinoma of the uterine cervix stage IB and IIA: results of postoperative irradiation in patients with microscopic infiltration in the parametrium and/or lymph node metastasis.

One hundred and thirty-two patients received postoperative radiation therapy following radical hysterectomy and pelvic lymphadenectomy for carcinoma of the uterine cervix Stage IB and IIA. In 43 patients with negative lymph node the 5- and 10-year survival rate was 85%. The other 89 patients with positive lymph node had 5- and 10-year survival rates of 60% and 51%, respectively. Multifactorial analysis of prognostic factors in the group of patients with lymph node metastasis disclosed pathology, microscopic infiltration in the parametrium and vascular space invasion as independent prognostic factors, that is, the 5-year survival rates were: 66% for squamous cell carcinomas versus, 25% for adenocarcinomas (p value: 0.001), 76% negative parametrium versus 39% positive parametrium (p value: 0.008), 68% no vascular space invasion versus 43% if invasion was observed (p value: 0.04). Sites of failure in 37 recurrences out of 89 patients with lymph node metastasis were pelvic alone 9, distant metastases alone 15, and combined pelvic plus distant metastasis in 12 patients. In one patient the site of failure was unknown. These data warrant more intensive local and systemic treatment, particularly in patients with poor prognostic factors. In the whole group, severe complications were observed in 11 patients.

The significance of microscopic involvement of the parametrium and/or pelvic lymph nodes in cervical cancer stages IB and IIA.

From 1961 through 1980, 388 patients with cervical carcinoma stage IB (272) and stage IIA (116) were treated by radical hysterectomy and pelvic lymphadenectomy. The operation specimens were divided into four groups: no involvement of the parametrium and pelvic lymph nodes (71.4%), involvement of the parametrium alone (7.2%), involvement of the pelvic lymph nodes alone (11.9%), and involvement of both the parametrium and pelvic lymph nodes (9.5%). Two hundred thirty-eight patients were followed for at least 5 years. The corrected 5-year survival figures for these four groups (stages IB and IIA together) were 90.3, 75.0, 62.1, and 50.0%, respectively. The differences are of statistical significance (P less than 0.005). Not only the stage of disease and involvement of the lymph nodes, but clearly also the involvement of the parametrium is of significance for the results of treatment in cervical cancer.