Large-scale data on maternal and neonatal outcomes of pregnancy-associated cervical cancer in Japan are scarce, and treatment strategies have not been established. This multicenter retrospective observational study investigated clinical features and trends in pregnancy-associated cervical cancer treatments at 523 hospitals in Japan. We included cervical cancer cases that were histologically diagnosed (between 1 January 2012, and 31 December 2017), and their clinical information was retrospectively collected. Of 40 patients diagnosed with pregnancy-associated cervical cancer at ≥22 gestational weeks, 34 (85.0%) were carefully followed until delivery without intervention. Of 163 diagnosed at <22 gestational weeks, 111 continued and 52 terminated their pregnancy. Ninety patients with stage IB1 disease had various treatment options, including termination of pregnancy. The 59 stage IB1 patients who continued their pregnancy were categorized by the primary treatment into strict follow-up, conization, trachelectomy, and neoadjuvant chemotherapy groups, with no significant differences in progression-free or overall survival. The birth weight percentile at delivery was smaller in the neoadjuvant chemotherapy group than in the strict follow-up group (p = 0.029). Full-term delivery rate was relatively higher in the trachelectomy group (35%) than in the other groups. Treatment decisions for pregnancy-associated cervical cancer are needed after estimating the stage, considering both maternal and fetal benefits.

Large-scale data on maternal and neonatal outcomes of pregnancy-associated cervical cancer in Japan are scarce, and treatment strategies have not been established. We conducted this multicenter retrospective observational study at 523 secondary/tertiary care hospitals in Japan to investigate the clinical features and trends in pregnancy-related cervical cancer treatments. We collected data for 290 patients with pregnancy-associated cervical cancer (during pregnancy, n=203; postpartum, n=87) diagnosed between January 1, 2012, and December 31, 2017. Of the 40 patients diagnosed at ≥22 gestational weeks, 34 (85.0%) were carefully followed until delivery without intervention. Of the 163 patients diagnosed at <22 gestational weeks, 111 and 52 patients continued and terminated their pregnancies, respectively. Although the termination rate increased with cervical cancer stage, 90 patients with stage IB1 disease had a variety of treatment options, including termination of pregnancy. When we divided the 59 stage IB1 patients who continued their pregnancy into four groups based on the primary treatment (strict follow-up, conization, trachelectomy, and neoadjuvant chemotherapy), there were no significant differences in progression-free or overall survival. The percentile of birth weight at delivery was smaller in the neoadjuvant chemotherapy group than in the strict follow-up group (P =.02). The full-term delivery rate was relatively higher in the trachelectomy group (35%) than in the other groups. In conclusion, treatment decisions, including pregnancy termination for pregnancy-associated cervical cancer, should be made after estimating the stage, with careful consideration of both maternal and fetal benefits. These findings will help in developing treatment guidelines for pregnancy-associated cervical cancer.