Retrasos en el Tratamiento y Resultados en Cánceres Asociados al Embarazo: Un Análisis Multicéntrico

Management of pregnancy-associated cancers (PACs)-malignancies diagnosed during pregnancy or within one year postpartum-poses unique clinical challenges. Treatment decisions must balance maternal cancer control with fetal safety, yet little is known about how cancer treatment timing varies between pregnant and nonpregnant individuals or how PACs impact obstetric and neonatal outcomes. Understanding these associations is critical to improving care strategies for this vulnerable population.

We conducted a retrospective cohort study using Epic Cosmos, a large multicenter U.S. electronic health record database. The primary "cancer" cohort included individuals aged 18 to 49 years diagnosed with cancer between January 2018 and December 2022. These individuals were categorized by pregnancy status at diagnosis: gestational PAC, postpartum PAC, or nonpregnant. A secondary "maternal" cohort comprised individuals with viable deliveries during the same period; gestational PAC pregnancies were matched 1:4 with cancer-unexposed pregnancies. Primary outcomes were time from cancer diagnosis to initiation of surgery, radiotherapy, and chemotherapy. Secondary outcomes included 30-day surgical complications, mortality, readmissions, and obstetric and neonatal outcomes such as cesarean delivery, preterm birth, low birth weight, and 5-minute Apgar scores.

Among 38,345 individuals in the cancer cohort (median age, 43 years [IQR, 38-47]), most were White (n=26,594; 71.3%) and married (n=19,230; 51.5%). Gestational PAC was associated with 15% longer time to surgery (aRR, 1.15; 95% CI, 1.13-1.17), 28% longer time to radiotherapy (aRR, 1.28; 95% CI, 1.27-1.29), and 29% shorter time to chemotherapy initiation (aRR, 0.71; 95% CI, 0.70-0.72) compared with nonpregnant controls. Postpartum PAC was associated with 13% shorter time to surgery (aRR, 0.87; 95% CI, 0.86-0.88) and 30% shorter time to chemotherapy (aRR, 0.70; 95% CI, 0.70-0.71). In the maternal cohort, gestational PAC was associated with higher odds of cesarean delivery (aOR, 1.21; 95% CI, 1.04-1.41), preterm birth (aOR, 3.79; 95% CI, 3.15-4.56), low birth weight (aOR, 3.08; 95% CI, 2.50-3.77), and low 5-minute Apgar scores (aOR, 1.86; 95% CI, 1.20-2.82).

Pregnancy-associated cancer was associated with delays in loco-regional treatment and increased maternal and neonatal morbidity, underscoring the need for coordinated multidisciplinary care to optimize outcomes for women with PACs.