Desfechos materno e perinatais em pacientes com câncer na gravidez atendidas no período de 2008 a 2020 em um serviço universitário
Data
2021-10-27
Autores
Ferraz, Bruna Elias Parreira Lopes 
Orientadores
Sun, Sue Yazaki
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O aumento da incidência de câncer na população mundial associado ao fato de as mulheres atualmente postergarem cada vez mais a gestação, tem levado a aumento crescente no número de pacientes com câncer na gravidez. A literatura define como câncer na gravidez quando a neoplasia maligna é diagnosticada no período da gestação ou até um ano após o parto. Por ser essa associação evento raro, 1 em cada 1000 gravidezes, não há na literatura ensaios clínicos randomizados sobre o assunto e os estudos disponíveis, são na sua maioria trabalhos retrospectivos, revisões sistemáticas ou relatos de casos. Objetivos: Analisar o perfil das pacientes atendidas no Setor de Neoplasias na Gestação do Hospital da Universidade Federal de São Paulo. Descrever os tipos de neoplasias malignas na gravidez mais frequentes e o tratamento oncológico empregado. Avaliar a resposta ao tratamento oncológico e sobrevida dessas pacientes assim como os desfechos obstétricos e perinatais de acordo com o tratamento utilizado. Métodos: Foi realizado estudo retrospectivo analítico de revisão de prontuários das gestantes com câncer na gravidez ou que engravidaram durante investigação/tratamento oncológico atendidas nesse serviço, no período de 01 de janeiro de 2008 a 31 dezembro de 2020, aprovado pelo CEP sob número CAAE 12770918.0.0000.5505. Os dados foram coletados nos prontuários físico, eletrônico, livro de parto do centro obstétrico e registros da neonatologia e inseridos em uma tabela criada para a pesquisa. Coletamos variáveis demográficas, clínicas, obstétricas e da neoplasia. A análise dos dados foram realizadas com o uso do software estatístico SPSS 20.0 e STATA 12. Resultados: Encontramos 39 pacientes com câncer durante a gravidez que foram divididas em dois grupos, Grupo 1 com 28 pacientes, aquelas que tiveram o diagnóstico da neoplasia na gravidez ou até 1 ano após, e Grupo 2 com 11 pacientes que estavam em investigação ou tratamento oncológico quando engravidaram. Os tipos de neoplasia mais encontrados foram de mama (G1=11, G2=3), colo de útero (G1=10, G2=3), hematológico (G1=2, G2=4), ovário (G1=2, G2=1), gastrointestinais (G1=2) e bexiga (G1=1). Os tipos de tratamento oncológico empregado foram cirurgia (N=11), quimioterapia (N= 21) e inadvertidamente, radioterapia em uma paciente. Vinte e cinco recém-nascidos nasceram no termo, houve um aborto tardio, um óbito fetal e um óbito neonatal. Trinta e dois recém-nascidos nasceram com peso adequado para a idade gestacional e 37 tiveram alta hospitalar. A indicação do parto nos recém-nascidos pré-termo foi obstétrica em oito casos (61,5%). A sobrevida global para cada tipo de tumor foi 54% no câncer de mama, 70% colo de útero, 100% hematológico, 50% gastrointestinal e 100% bexiga. E a sobrevida global de todos os tumores foi 70,9%. Conclusão: Ao contrário da literatura internacional encontramos o câncer de colo de útero como o segundo mais frequente na gravidez. A maioria dos nascimentos ocorreram no termo (65,8%) e recém-nascidos com peso adequado (86,5%). Apesar do tratamento oncológico durante a gravidez, houve 37 recém-nascidos com alta hospitalar acompanhados das mães.
Introduction: The increasing of world population cancer incidence, associated with the fact that women nowadays continuously postpone pregnancy, has led to the steady increasing of cancer during pregnancy. The literature defines cancer during pregnancy as the malignant neoplasia diagnosed in pregnancy period or even one year postpartum. Because it is a rare event, 1 each 1000 pregnancies, there is no randomized clinical trial about it on literature, and the available studies are, mostly, retrospective studies, systematic reviews or case reports. Objectives: To analyze patient’s profile on the Neoplasia Sector of São Paulo’s Federal University Hospital. To describe most frequent malignant neoplasia types during pregnancy and the oncological treatment used. To survey oncological treatment response and survival of patients, as well as obstetric and perinatal outcome according to treatment used. Methods: It was performed a retrospective analytical study of revision of pregnant patient’s records, cared in this service, which had cancer during pregnancy or got pregnant during oncological investigation/treatment, from January 1st, 2008, to December 31rst, 2020, approved by CEP under the CAAE number 12770918.0.0000.5505. Data were collected through physical/electronical record, labor textbook from obstetric center and neonatology register, and added in a data base created to the research. It was collected demographic, clinical, obstetrical and neoplastic variables. Data analyses were performed on SPSS 20.0 and STATA 12 statistical software. Results: it was identified 39 patients with cancer during pregnancy, that are separated in two groups, Group 1 with 28 patients, those who had the diagnose of cancer during pregnancy or even one year postpartum, and Group 2 with 11 patients, those who were under oncological investigation/treatment when got pregnant. The most found neoplasia types were breast (G=11, G2=3), uterine cervical (G=10, G2=3), hematological (G1=2, G2=4), ovary (G1=2, G2=1), gastrointestinal (G1=2) and bladder (G1=1). The oncological treatment types used were surgery (N=11), chemotherapy (N=21) and, inadvertently, radiotherapy in one patient. Twenty-five newborns were born in term; there was one late miscarriage, one fetal death and one neonatal death. Thirty-two newborns were born with appropriate weight according to gestational age and thirty seven had hospital discharge. The delivery route indication of pre-term newborns was obstetrical on 8 cases (61,5%). The patient’s overall survival for each disease were 54% to breast cancer, 70% to uterine cervical cancer, 100% to hematological cancer, 50% to gastrointestinal cancer and 100% to bladder cancer, and overall survival was 70,9% in five years. Conclusion: Unlike international literature, it was found that uterine cervical cancer is the second most frequent cancer during pregnancy. Most births happened in term (65,8%) and with newborns with appropriate weight (86,5%). Despite oncological treatment during pregnancy, there were 37 newborns with hospital discharge.
Introduction: The increasing of world population cancer incidence, associated with the fact that women nowadays continuously postpone pregnancy, has led to the steady increasing of cancer during pregnancy. The literature defines cancer during pregnancy as the malignant neoplasia diagnosed in pregnancy period or even one year postpartum. Because it is a rare event, 1 each 1000 pregnancies, there is no randomized clinical trial about it on literature, and the available studies are, mostly, retrospective studies, systematic reviews or case reports. Objectives: To analyze patient’s profile on the Neoplasia Sector of São Paulo’s Federal University Hospital. To describe most frequent malignant neoplasia types during pregnancy and the oncological treatment used. To survey oncological treatment response and survival of patients, as well as obstetric and perinatal outcome according to treatment used. Methods: It was performed a retrospective analytical study of revision of pregnant patient’s records, cared in this service, which had cancer during pregnancy or got pregnant during oncological investigation/treatment, from January 1st, 2008, to December 31rst, 2020, approved by CEP under the CAAE number 12770918.0.0000.5505. Data were collected through physical/electronical record, labor textbook from obstetric center and neonatology register, and added in a data base created to the research. It was collected demographic, clinical, obstetrical and neoplastic variables. Data analyses were performed on SPSS 20.0 and STATA 12 statistical software. Results: it was identified 39 patients with cancer during pregnancy, that are separated in two groups, Group 1 with 28 patients, those who had the diagnose of cancer during pregnancy or even one year postpartum, and Group 2 with 11 patients, those who were under oncological investigation/treatment when got pregnant. The most found neoplasia types were breast (G=11, G2=3), uterine cervical (G=10, G2=3), hematological (G1=2, G2=4), ovary (G1=2, G2=1), gastrointestinal (G1=2) and bladder (G1=1). The oncological treatment types used were surgery (N=11), chemotherapy (N=21) and, inadvertently, radiotherapy in one patient. Twenty-five newborns were born in term; there was one late miscarriage, one fetal death and one neonatal death. Thirty-two newborns were born with appropriate weight according to gestational age and thirty seven had hospital discharge. The delivery route indication of pre-term newborns was obstetrical on 8 cases (61,5%). The patient’s overall survival for each disease were 54% to breast cancer, 70% to uterine cervical cancer, 100% to hematological cancer, 50% to gastrointestinal cancer and 100% to bladder cancer, and overall survival was 70,9% in five years. Conclusion: Unlike international literature, it was found that uterine cervical cancer is the second most frequent cancer during pregnancy. Most births happened in term (65,8%) and with newborns with appropriate weight (86,5%). Despite oncological treatment during pregnancy, there were 37 newborns with hospital discharge.
Descrição
Citação
PARREIRA, B.E. Desfechos maternos e perinatais em pacientes com câncer na gravidez atendidas no período de 2008 a 2020 em um serviço universitário. São Paulo, 2021. 157 f. Dissertação (Mestrado em Obstetrícia) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). São Paulo, 2021.