RESUMEN
OBJECTIVE: This study was undertaken to identify the prognostic indicators associated with postpartum regression of cervical dysplasia diagnosed in pregnancy. STUDY DESIGN: A retrospective cohort study of pregnant women referred for colposcopy from 2004-2007 at four academic centers. RESULTS: One thousand seventy-nine patients were identified. Colposcopic impression by cervical cytology is detailed later in the text. Of patients who underwent biopsy, results correlated with or were less severe than colposcopic impression in 83% with CIN 1 and 56% with CIN 2/3. Fifty-seven percent had follow-up postpartum, with 61% reverting to normal. Resolution of cervical dysplasia was inversely associated with smoking (P = .002). No progression to cancer occurred during pregnancy. CONCLUSION: Colposcopic impression in pregnancy correlated with cervical biopsy results and postpartum colposcopic findings when performed by expert colposcopists. A high proportion of cervical dysplasia regressed postpartum. Cervical biopsies in pregnancy may not be necessary unless invasive cancer is suspected.
Asunto(s)
Complicaciones Neoplásicas del Embarazo/epidemiología , Resultado del Embarazo , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/patología , Neoplasias Uterinas/patología , Centros Médicos Académicos , Adulto , Distribución por Edad , Biopsia con Aguja , Estudios de Cohortes , Colposcopía/métodos , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Inmunohistoquímica , Incidencia , Análisis Multivariante , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/patología , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Atención Prenatal , Probabilidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Displasia del Cuello del Útero/diagnóstico , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/epidemiología , Frotis Vaginal , Adulto JovenRESUMEN
BACKGROUND: Patients aged > or = 80 years who are diagnosed with advanced ovarian cancer (OC) have been reported to have a poor prognosis. In the current study, chemotherapy-related toxicity data were evaluated between patients aged > or = 80 years and those aged < 80 years. METHODS: Patients with OC who underwent cytoreductive surgery with chemotherapy were included. Self-reported toxicity data were obtained from National Cancer Institute Common Toxicity Criteria (CTC) forms. Objective indicators of status including albumin level, weight, and creatinine clearance were abstracted both before and after therapy. Data were compared between patients by decade of age. RESULTS: A total of 246 patients were included. A presenting Karnofsky performance status >2 was recorded in 17% of patients aged > or = 80 years versus 0% to 4% of patients aged < 80 years (P = .002). Platinum-based chemotherapy was used in all patients. For patients aged < 80 years, combination chemotherapy was used in > 90% versus 69% in those aged > or = 80 years (P < .0001). Standard-dose combination therapy was used in 72% to 86% of patients aged <80 years versus 28% of patients aged > or =80 years (P < .0001). Patients aged > or =80 years completed > or =6 cycles of therapy approximately 57% of the time versus 84% to 97% of the time for those aged < 80 years (P = .0001). CTC forms identified no self-reported toxicities to be more common among patients aged > or =80 years. Multivariate logistic regression identified creatinine clearance < 65 mL/minute (odds ratio [OR] of 4.6), 5% weight loss (OR of 2.5), prechemotherapy albumin level of < 2 g/dL (OR of 3.65), and initiation of therapy with a single agent (OR of 3.9) as independent predictors of failure to complete chemotherapy. CONCLUSIONS: Despite initial treatment modifications as well as toxicity assessment, only 57% of patients aged > or =80 years completed planned chemotherapy. It was confirmed that further studies into the pharmacokinetics of chemotherapy in the elderly and more sensitive assessment of therapy-related toxicity are required.