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Pregnancy does not increase risk for women with adrenocortical carcinoma
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Women treated for adrenocortical carcinoma who go on to become pregnant have similar survival rates vs. women treated for the aggressive tumors who do not become pregnant, according to research in The Journal of Clinical Endocrinology & Metabolism.
In a retrospective study of all women with adrenocortical carcinoma (ACC) in the French, German and Brazilian databases of the European Network for the Study of Adrenal Tumors, researchers also found that most women with ACC who became pregnant went on to deliver full-term, healthy infants.
Pauline de Corbiere, of Ambroise Pare University Hospital, Boulogne Billancourt, France, and colleagues analyzed data from 17 women with localized adrenocortical carcinoma who became pregnant at least 3 months after their initial treatment (median time between surgery and conception, 4 years), and 247 women with adrenocortical carcinomas who were not pregnant and younger than 47 years. All women in the pregnancy group underwent surgical treatment; 12 women received mitotane therapy after surgery. For survival analysis, researchers used a control group of 34 patients matched for age, sex and tumor stage.
In the pregnancy group, 16 women gave birth to 19 live infants; two pregnancies were terminated at 8 weeks; one infant had an unrelated cardiac malformation. There were no signs of adrenal insufficiency observed in the infants. After median follow-up of 8.36 years, one of the women in the pregnancy group died; five experienced a recurrence, three of whom had a relapse before becoming pregnant.
Researchers found that overall survival was not significantly different between the pregnancy group and controls. However, the researchers noted that there may be a bias in the pregnancy group, as women considering a future pregnancy are a self-selecting population.
“‘Healthy mother effect’ refers to the fact that only women who feel good health will undertake a pregnancy,” the researchers wrote. “They may constitute a population with a notably better survival, which may mask an increased risk of relapse induced by the pregnancy.”
Researchers also noted that women with ACC may experience a protective benefit from pregnancy.
“Our data may suggest that women with ACC in the capacity to become pregnant may not only be unharmed by the pregnancy but may actually have an improved outcome as compared to women without such capacity,” the researchers wrote. “At this time, we are not able to evaluate whether this is caused by a self-selection mechanism or a biological impact of pregnancy.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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