Characteristics and outcomes of patients with pregnancy-associated colorectal cancer

Pregnancy-associated colorectal cancer (PACRC) is a rare condition with limited existing research. Its occurrence during pregnancy introduces unique physiological complexities, making diagnosis and treatment particularly challenging for clinicians. This study aimed to characterize PACRC by examining its clinical features, obstetric management approaches, therapeutic strategies, and maternal-fetal survival outcomes.

A comprehensive literature review was conducted using studies published from January 2016 to March 2024. Cox proportional hazards regression was used to identify prognostic factors affecting overall survival (OS). Chi-square tests were used to assess differences in fetal mortality and preterm birth rates across exposure groups.

A total of 121 PACRC patients were included, and most were diagnosed in late pregnancy or postpartum. PACRC was more frequently located in the left colon and rectum, typically diagnosed at advanced stages. Most tumors were moderately or poorly differentiated adenocarcinomas. The 1-year and 2-year maternal survival rates were 69.90% and 58.60%, respectively. Prognosis was more favorable when the tumor is in the rectum rather than the colon. Surgical intervention and chemotherapy, particularly when initiated during pregnancy, were associated with significantly improved outcomes compared to postpartum therapy (HR = 0.36; 95% CI: 0.16-0.84; P = .02). Fetal mortality was not directly associated with prenatal diagnostic or therapeutic procedures, although iatrogenic pregnancy termination may contribute to fetal risk.

PACRC, characterized by its subtle presentation, requires vigilant clinical monitoring and prompt intervention, with consideration of gestational age, histological type, and tumor stage. Our findings suggest that early surgical intervention and chemotherapy during pregnancy may offer greater survival benefits than treatment initiated only after pregnancy termination.