Risks of adverse obstetric outcomes among female survivors of adolescent and young adult cancer in England (TYACSS): a population-based, retrospective cohort study.

IF 41.6 1区 医学 Q1 ONCOLOGY Lancet Oncology Pub Date : 2024-08-01 Epub Date: 2024-06-26 DOI:10.1016/S1470-2045(24)00269-9
Ceren Sunguc, David L Winter, Emma J Heymer, Gavin Rudge, Angela Polanco, Katherine A Birchenall, Melanie Griffin, Richard A Anderson, W Hamish B Wallace, Michael M Hawkins, Raoul C Reulen
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Abstract

Background: There are limited data on the risks of obstetric complications among survivors of adolescent and young adult cancer with most previous studies only reporting risks for all types of cancers combined. The aim of this study was to quantify deficits in birth rates and risks of obstetric complications for female survivors of 17 specific types of adolescent and young adult cancer.

Methods: The Teenage and Young Adult Cancer Survivor Study (TYACSS)-a retrospective, population-based cohort of 200 945 5-year survivors of cancer diagnosed at age 15-39 years from England and Wales-was linked to the English Hospital Episode Statistics (HES) database from April 1, 1997, to March 31, 2022. The cohort included 17 different types of adolescent and young adult cancers. We ascertained 27 specific obstetric complications through HES among 96 947 women in the TYACSS cohort. Observed and expected numbers for births and obstetric complications were compared between the study cohort and the general population of England to identify survivors of adolescent and young adult cancer at a heighted risk of birth deficits and obstetric complications relative to the general population.

Findings: Between April 1, 1997, and March 31, 2022, 21 437 births were observed among 13 886 female survivors of adolescent and young adult cancer from England, which was lower than expected (observed-to-expected ratio: 0·68, 95% CI 0·67-0·69). Other survivors of genitourinary, cervical, and breast cancer had under 50% of expected births. Focusing on more common (observed ≥100) obstetric complications that were at least moderately in excess (observed-to-expected ratio ≥1·25), survivors of cervical cancer were at risk of malpresentation of fetus, obstructed labour, amniotic fluid and membranes disorders, premature rupture of membranes, preterm birth, placental disorders including placenta praevia, and antepartum haemorrhage. Survivors of leukaemia were at risk of preterm delivery, obstructed labour, postpartum haemorrhage, and retained placenta. Survivors of all other specific cancers had no more than two obstetric complications that exceeded an observed-to-expected ratio of 1·25 or greater.

Interpretation: Survivors of cervical cancer and leukaemia are at risk of several serious obstetric complications; therefore, any pregnancy should be considered high-risk and would benefit from obstetrician-led antenatal care. Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors of adolescent and young adult cancer concerning their risk of almost all obstetric complications. Our results provide evidence for the development of clinical guidelines relating to counselling and surveillance of obstetrical risk for female survivors of adolescent and young adult cancer.

Funding: Children with Cancer UK, The Brain Tumour Charity, and Academy of Medical Sciences.

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英格兰青少年和年轻成人癌症女性幸存者的不良产科结果风险(TYACSS):一项基于人群的回顾性队列研究。
背景:有关青少年和青年癌症幸存者产科并发症风险的数据有限,之前的大多数研究仅报告了所有类型癌症的综合风险。本研究旨在量化17种特定类型的青少年和青年癌症女性幸存者的出生率缺陷和产科并发症风险:方法:1997 年 4 月 1 日至 2022 年 3 月 31 日,青少年和年轻成人癌症幸存者研究(Teenage and Young Adult Cancer Survivor Study,TYACSS)与英国医院病例统计(Hospital Episode Statistics,HES)数据库相连接,该研究是一项基于人群的回顾性队列,共有 200 945 名来自英格兰和威尔士的 15-39 岁癌症 5 年期幸存者。该队列包括 17 种不同类型的青少年和年轻成人癌症。我们通过 HES 确定了 TYACSS 队列中 96 947 名妇女的 27 种特定产科并发症。我们比较了研究队列和英格兰一般人群的出生和产科并发症的观察数和预期数,以确定与一般人群相比,青少年和年轻成人癌症幸存者患出生缺陷和产科并发症的风险更高:1997年4月1日至2022年3月31日期间,在英格兰13 886名青少年和青年癌症女性幸存者中观察到2 1437例分娩,低于预期(观察值与预期值之比:0-68,95% CI 0-67-0-69)。其他泌尿生殖系统癌症、宫颈癌和乳腺癌幸存者的生育率低于预期的 50%。就至少中度超标(观察值与预期值之比≥1-25)的较常见(观察值≥100)产科并发症而言,宫颈癌幸存者面临胎位不正、难产、羊水和胎膜疾病、胎膜早破、早产、胎盘疾病(包括前置胎盘)和产前大出血的风险。白血病幸存者有早产、难产、产后出血和胎盘滞留的风险。所有其他特定癌症的幸存者中,没有两种以上的产科并发症的观察值与预期值的比率超过1-25或更高:解释:宫颈癌和白血病幸存者有可能出现多种严重的产科并发症;因此,任何妊娠都应被视为高风险妊娠,并从产科医生主导的产前护理中获益。尽管在所有 17 种不同类型的青少年和青年癌症中都观察到了出生率方面的缺陷,但我们还是为几乎所有青少年和青年癌症幸存者提供了有关其几乎所有产科并发症风险的保证。我们的研究结果为制定有关青少年和青年癌症女性幸存者产科风险咨询和监测的临床指南提供了证据:资助机构:英国癌症儿童协会、脑肿瘤慈善机构和医学科学院。
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来源期刊
Lancet Oncology
Lancet Oncology 医学-肿瘤学
CiteScore
62.10
自引率
1.00%
发文量
913
审稿时长
3-8 weeks
期刊介绍: The Lancet Oncology is a trusted international journal that addresses various topics in clinical practice, health policy, and global oncology. It covers a wide range of cancer types, including breast, endocrine system, gastrointestinal, genitourinary, gynaecological, haematological, head and neck, neurooncology, paediatric, thoracic, sarcoma, and skin cancers. Additionally, it includes articles on epidemiology, cancer prevention and control, supportive care, imaging, and health-care systems. The journal has an Impact Factor of 51.1, making it the leading clinical oncology research journal worldwide. It publishes different types of articles, such as Articles, Reviews, Policy Reviews, Personal Views, Clinical Pictures, Comments, Correspondence, News, and Perspectives. The Lancet Oncology also collaborates with societies, governments, NGOs, and academic centers to publish Series and Commissions that aim to drive positive changes in clinical practice and health policy in areas of global oncology that require attention.
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