Lancet Oncology:迄今为止规模很大、时间最长:怀孕癌症患者,可以放化疗吗?

2018-01-30 MedSci MedSci原创

孕期癌症,可以放化疗吗?

怀孕期间查出癌症,接不接受放化疗呢?放化疗会不会影响胎儿的发育呢?

根据研究显示:孕期被诊断为癌症的概率约为千分之一。然而挽救母亲生命的抗肿瘤治疗往往会对胎儿的生长发育产生影响,大多数情况下,医生会建议终止妊娠。

2015年,发表在新英格兰杂志上面的一项研究就显示:妊娠期母亲进行肿瘤治疗并未明显影响儿童的生长发育,包括一般健康状况、认知发育和心脏结构与功能。这一结果的可能原因是化疗时机的正确选择和胎盘屏障的存在,因为妊娠早期是胎儿器官形成的关键时期,所有化疗都选择在妊娠的中晚期;同时胎盘屏障的存在使宫内的药物浓度降到了最低,减少了药物对胎儿的可能的危害。

而在今年1月24日发表在《The Lancet Oncology》上面一篇名为“Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients”的文章则为我们带来了研究的最新进展。这应该是目前规模最大、时间最长的相关研究。

随着人们对于癌症的认知不断深入,同时癌症治疗手段的不断发展,在怀孕期间进行治疗也是可行的,但是癌症治疗是否会对胎儿产生影响呢?研究人员通过在INCIP注册的患者的肿瘤管理和其在产科的新生儿的健康状况,来分析不同癌症类型和其采取的治疗方法是否会对新生儿产生影响。

本次研究共计纳入来自16个国家37个参与INCIP登记的中心,对1996年1月1日至2016年11月1日期间被诊断为原发性浸润癌肿瘤患者进行回顾性的数据分析。

这次分析共计纳入了1170例患者,而在这其中有共计779例患者在妊娠期间被确诊为癌症并且接受了化疗,占据统计人数的67%。数据分析显示:每隔5年妊娠期接受治疗的概率都会上升,这个大概可以归功于治疗方式和药物的不断进展。(不得不提一句的是:在779例确认为癌症的妊娠期女性中,乳腺癌是最常见的癌症,共计462例,占据总体人数的39%。早检查、早预防很重要。)

在本次研究中发现:铂类药物化疗和胎儿早产有关;紫杉类化疗同新生儿入住重症监护病房有关。

那么癌症类型会不会影响新生儿呢?答案当然是会的!数据表明:新生儿入住重症监护病房可能和母亲所患癌症相关——胃肠道癌症造成的风险最大,而相对而言,甲状腺癌风险最低。另外,出人意料的是,数据显示腹部或颈部手术可能会降低新生儿入住NICU。

当然妊娠期癌症化疗和新生儿之间的联系依旧需要我们进一步的研究。而在2017年4月份,《The Lancet Oncology》上面同样刊登了一篇孕期癌症资料的研究。在这个研究中,发现接受和不接受化疗的产妇婴儿在出生缺陷上并没有明显差异,当然,暴露于化疗之下的新生儿有轻微的体重降低。当然所有的研究几乎都建立在避开妊娠早期的前提下。目前来说建议女性在孕期前三月依然是避免化疗,在妊中期的三个月和妊后期的三个月进行化疗。

影响新生儿一个重要因素——是否早产。足月生产是孕妇生出健康宝宝的重要因素。最新的研究表明化疗药物和早产之间存在着联系,因此使用化疗药物时应该根据医生建议进行抉择。

根据最新的研究显示:根据癌症的不同,放化疗对于新生儿的影响不同;化疗药物可能会引起胎儿早产从而影响胎儿健康;另外,乳腺癌需要我们投入更多的精力去重视。

而对于孕期家庭而言,在权衡母婴的情况时,毫无疑问应该以母亲的身体健康为优先考虑条件。

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    2018-03-02 howi
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    2018-09-27 minlingfeng
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    2018-02-01 yzh399
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