- General Features and Clinical Presentation
During Janury 2009 to December 2019, a total of 6871 patients were diagnosed with gastric cancer in our hospital, of which, 22 (0.32%) were with prengnancy. Their median age was 32 years ( 26.0 to 41.0 years). All the patients were diagnosed with gastric cancer during pregnancy period. And the median gestational age at diagnosis was 27 weeks ( 9.0 to 37.0 weeks). Of 22 patients, 4 patients had gastric cancer family history. Abdominal pain (6/22, 27.3%) was the most common presentation, and other symptoms were nausea and/or vomiting (3/22, 13.6%) , nonspecific dyspepsia (3 cases, 13.6%), and melena (1 case, 4.5%). Other 9 patients (41.0%) were identified with metastatic features, including ascites, abdominal distention, jaundice and abdominal mass .
- Treatment and Survival
Of the 22 patients, 5 cases(22.7%) received curative gastrectomy, 5 patients (22.7%) received chemotherapy,and other 12 patients (54.6%) received supportive therapy. Of all 22 patients, the median survival time was 8.0 months ( 2.3 to 25.8 months).
As to the patients who received different therapy, the survival time was 30.5 months (20.4 to 74.0 months) of those who received gastrectomy, 5.2 months ( 0.8 to 6.4 months) of those who received chemotherapy and 1.6 months (0.7 to 11.5 months) for that only received supportive treatment. Of all the patients, the median interval time from the onset of symptoms to diagnosis was 75.4 days (28 to 139 days), and the time from pathological diagnosis to treatment was 19 days (8.0 to 29.0 days).
- Obstetrics Outcome
Of the 22 patients, 14 patients (63.6%) terminated the pregnancy. And the median termination age was 13.0 weeks (9.0 to 22.0 weeks). The remaining 8 patients received cesarean section, and the median operated time was 34.2 weeks (28.0 to 36.0 weeks). Of all the patients, there was no obstetric complications or fetal metastasis. Microscopic placental metastasis was found in two patients. The clinical features and outcomes of the case group is summarized in Table 1.
- The Clinicopathological Features of Gastric Cancers
In order to analyze the factors that associated with the prognosis of pregnency with gastric cancer, we used case contral by matching two gastric cancer patients without pregnancy. The characteristic factors of the case group and control group are summarized in Table2.
From the table we can see that in the contral group, median overall survival time was 11.0 month, three month longer than in case group(P=0.05). As to the clinical presentation, abdominal pain was the most common in case group while dyspepsia in control group(p=0.087). On the tumor location, it was amost equal to see in antrum, corpus, and entire stomach of the case group, while in the contral group the corpus was the most (72.7%). In both groups the gastric cancers were mostly advanced, and the stage IV were 81.8% in the case and 93.2% in the contral group, respectively. On the treatment, there was 22.7% and 25% percent patients received curative gastrectomy, 22.7% and 22.7% of the case and control group patients received chemotherapy. Almost all patients of the two group were signet ring cell carcinomas or poorly differentiated.
- Prognosis Related Factors
In order to identify the factors that associated with survival, we analyze the case group and the case plus control cohort. Of all the factors, age, tumor stage, diagnosis period, tumor location, were analyzed. In the case group, stage IV (p=0.048), tumor involved the entire stomach (p=0.022) were associated with the highest risk of death. However, age, pregnancy week,treatment and other factors had no relationship with the overall survival .
Of the cases plus controls cohort, all the factors were analyzed using the same method The result showed that the tumor stage had significant influence to prognosis (p<0.001). And the tumor location was associated significantly with a poor prognosis, while the corpus location had a p value=0.045 and the entire stomach had a p value =0.021. Other factors such as age, pregnancy week,treatment and other factors had no relationship with prognosis.