Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2025; 31(17): 106508
Published online May 7, 2025. doi: 10.3748/wjg.v31.i17.106508
Clinicopathological characteristics and prognostic outcomes of pregnancy-associated colorectal cancer: A 24-year experience
Li-Wen Fan, Chao Shang, Qi Lin, Yan-Tao Tian, Dong-Kui Xu
Li-Wen Fan, Qi Lin, School of Clinical Medicine, The Hebei University of Engineering, Handan 056000, Hebei Province, China
Chao Shang, Dong-Kui Xu, Department of VIP, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Co-first authors: Li-Wen Fan and Chao Shang.
Co-corresponding authors: Yan-Tao Tian and Dong-Kui Xu.
Author contributions: Fan LW, Shang C, Lin Q, Tian YT, and Xu DK conceived and designed the study and analyzed the data; Fan LW and Shang C interpreted the data and drafted the manuscript, they contributed equally as co-first authors; Lin Q contributed to statistical analysis; Tian YT and Xu DK provided critical feedback and approved the final manuscript, they contributed equally to this manuscript and as co-corresponding authors.
Supported by the National Natural Science Foundation of China, No. 82372989.
Institutional review board statement: The studies involving human participants were supported by the ethics and research committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (approval number: 24/363-4643).
Informed consent statement: All of the patients’ personal identifiable information was removed before use, and individual consent for this retrospective analysis was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Kui Xu, MD, Chief Physician, Professor, Department of VIP, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. 13691583382@163.com
Received: March 3, 2025
Revised: March 27, 2025
Accepted: April 22, 2025
Published online: May 7, 2025
Processing time: 60 Days and 7.9 Hours
Abstract
BACKGROUND

Colorectal cancer (CRC) during pregnancy poses significant risks to both maternal and fetal health; however, this topic remains under researched globally.

AIM

To investigate the impacts of clinical features, pathology type, treatment strategies, and tumor stage on maternal and fetal outcomes in pregnant patients with pregnancy-associated CRC (pCRC).

METHODS

To address this research gap, we analyzed the clinical and pathological characteristics of pCRC by collecting and evaluating clinicopathological data from 43 patients treated at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, between 1999 and 2023 using descriptive statistical methods.

RESULTS

Treatment for pCRC was initiated with surgery and/or chemotherapy. Among 43 patients, 37 underwent surgery, including 21 radical resections (5 prenatal and 16 postpartum resections) and 16 palliative surgeries. Chemotherapy (with regimens such as CapeOx or FOLFOX4) was administered to 37 patients. Six advanced-stage patients received chemotherapy alone. The gestational outcomes among the patients varied. Specifically, 5 patients who were diagnosed in early pregnancy chose abortion. Additionally, in mid-pregnancy, 3 patients underwent abortion, 1 required induced labor, and 2 underwent cesarean delivery with healthy neonates. Among the 3 late-pregnancy diagnoses, 1 patient underwent induced abortion, 1 delivered via cesarean section with a healthy fetus, and 1 underwent stillbirth management. The 5-year survival rate was 59.8%, with a rate of 100% for stage I/II patients, 75% for stage III patients, and 21.1% for stage IV patients.

CONCLUSION

Patients with poorly differentiated tumors exhibited worse outcomes than those with moderately and highly differentiated tumors. Early-stage diagnosis and timely treatment significantly improved maternal survival and fetal outcomes in pregnant patients with CRC. Advanced tumor stages and delayed diagnosis were observed to be associated with poorer maternal prognoses and may require interventions that compromise fetal survival. Fetal outcomes depend on the pathological stage of the mother’s cancer, the gestational age at diagnosis, and treatment strategies.

Keywords: Pregnancy-associated colorectal cancer; Gestational outcomes; Tumor treatment; Survival rate; Pathological type; Clinical features

Core Tip: Pregnancy-associated colorectal cancer (pCRC) is a rare disease with a poor prognosis. Research on the prognosis of pCRC, particularly regarding factors influencing maternal and fetal outcomes, remains limited in Asia. This study encompassed all pCRC patients from Chinese cancer centers over a 24-year period and employed rigorous retrospective research methods. The findings highlight that while tumor location and advanced maternal age did not significantly impact survival, tailored strategies balancing maternal and fetal health are crucial, especially in cases of poorly differentiated tumors and advanced-stage disease.