Lack of effect of tumor size on the prognosis of carcinoma of the uterine cervix stage IB and IIA treated with preoperative irradiation and surgery (2023)

Citation Excerpt :

The rationale of this debated option is to optimize the local control and to potentially decrease the need for postoperative EBRT because of adverse histological findings on hysterectomy specimen. Although no randomized trial has demonstrated the benefit of a preoperative brachytherapy in patients with an early stage cervical cancer, retrospective reports have examined the clinical outcome of patients treated according to this radiosurgical modality and shown high local control rates and a satisfactory toxicity profile [6–14]. Our retrospective experience of preoperative brachytherapy as part of a multimodal strategy is reported.

To report clinical results of a multimodal strategy based on preoperative brachytherapy followed with surgery in early stage cervical cancer.

The outcome of consecutive patients receiving brachytherapy in our Institution for an early stage IB1-IIA1 invasive cervical cancer with risk factors (lymphovascular embols and/or tumor >2cm) between 2000 and 2013 was analyzed. The treatment consisted of preoperative low dose or pulse dose-rate utero-vaginal brachytherapy followed, 6–8weeks later, by a radical hysterectomy/bilateral salpingo-oophorectomy plus pelvic±para-aortic lymph node dissection. A postoperative chemoradiation was delivered in patients with histological evidence of lymph nodes metastases.

182 patients were identified. Histological examination of hysterectomy specimen showed the presence of a tumor residuum in 55 patients (30.2%). One patient (0.5%) had residual tumor cells in the parametria. With a median follow-up of 5.3years, 14 patients (7.7%) presented tumor relapse, including three (1.6%) local relapses. Five-year disease-free survival (DFS) rate was 93.6% (95%CI: 91.6–95.6%). In log-rank analysis, presence of pelvic nodal metastases at time of lymphadenectomy (p=0.001) and tumor size ≥3cm (p=0.003) correlated with a poorer DFS. Presence of a tumor residuum on hysterectomy specimen correlated with a higher risk of pelvic or para-aortic failure (p=0.035). A time interval>10weeks between brachytherapy and surgery correlated with a higher risk of failure outside the pelvis (p=0.003). Significant postoperative complications were reported in 16 patients (8.8%). All delayed toxicities were mild to moderate.

A preoperative brachytherapy is a safe and effective option in early stage cervical cancer.

To examine the clinical results of a preoperative image-guided pulse-dose-rate brachytherapy (PDR-BT) in early stage cervical cancer.

We examined the outcome of consecutive patients with early stage cervical cancer undergoing preoperative image-guided PDR-BT between 2004 and 2013 because of risk factors (lymphovascular embols and/or tumour>2cm). The objective was to deliver 60Gy to 100% of the intermediate risk clinical target volume. Brachytherapy was followed, 6–8weeks later, by a radical hysterectomy/bilateral salpingo-oophorectomy plus pelvic +/− para-aortic lymph node dissection. Patients with positive lymph nodes had postoperative chemoradiation.

77 patients met the above criteria of preoperative PDR-BT. On hysterectomy specimen, 54 (70.1%) presented a complete histological response. Four (5.2%) had a tumour residuum⩾1cm. Median follow-up was 46.8months. 5-Year disease-free survival (DFS) rate was 84.4%. Only one local recurrence was observed. The presence of lymph nodal metastases, a tumour size>3cm and a brachytherapy/surgery time interval⩾9weeks correlated with a poorer DFS. Six postoperative complications were encountered (7.8%). Total reference air kerma correlated with late vaginal toxicity (p=0.02).

A preoperative image-guided PDR-BT was safe and effective. Predictive factors for survival and toxicity were evidenced.

Citation Excerpt :

However, HDR regimen remains the unique brachytherapy procedure, which enables a treatment in a nonshielded room leading to greater patient quality of life (possible family visits and no sensation of loneliness) (27). We obtained a high rate of complete pathologic response despite an EQD2 of 47 Gyαβ10, which could be judged insufficient compared with the standard dose of 60 Gy classically delivered through LDR brachytherapy (13–17). The rational of this specific HDRB protocol derived from interstitial HDRB was used for partial breast irradiation.

To analyze dose–volume histogram parameters and pathologic response after preoperative high-dose-rate brachytherapy (HDRB) for high-risk early stage cervical cancers (ESCCs).

From June 2007 to December 2011, 32 patients with a histologically proven invasive cervical cancer with high risk of local recurrence (size >2cm, adenocarcinoma type, perineural and/or lymphovascular invasion) underwent a preoperative HDRB, which delivered a total dose of 39Gy in nine fractions over 5 days. All the patients underwent hysterectomy after HDRB.

With a median clinical target volume of 50cc (minimum–maximum, 42–74), the median V₁₀₀ was 49cc (minimum–maximum, 42–50). Median D₉₀ was 45Gy (equivalent dose at 2Gy per fraction, 56Gy_αβ10). Median D_2cc was 34Gy, 31Gy, 28Gy, and 38Gy_αβ3 for bladder, rectum, sigmoid, and vagina, respectively. Twenty-eight patients (88.5%) achieved a complete histologic response after surgery, whereas for the 4 remaining patients, residual tumor cells (3 patients) and gross residual disease (1 patient) were observed in the pathologic specimen. With a median followup of 24 months (minimum–maximum, 5–48), no local recurrence was observed; 1 patient died of intercurrent cause. Early toxicity occurred within the 30 days after HDRB (Common Terminology Criteria for Adverse Events v3.0) was G1 diarrhea for 15 patients (47%) and G1 urinary frequency or urgency for 13 patients (40.6%). No G2–G3 toxicities were noticed.

Preoperative HDRB for high-risk ESCCs represents a well-tolerated procedure, which leads to a high rate of postoperative pathologic response. Dose–volume histogram parameters were at least equivalent to those obtained with a low-dose-rate procedure. Long-term results will help to analyze the place of preoperative brachytherapy in the management of high-risk ESCCs.

Citation Excerpt :

Despite advances in chemotherapy and radiation therapy, some 4,000 women in the United States die annually from cervical cancer (1). Many well-known pretreatment prognostic factors exist for this disease, including clinical staging, tumor diameter, tumor volume, and depth of stromal invasion (2–5), Nevertheless, among patients risk stratified by these traditional criteria, a large heterogeneity exists in their clinical outcomes (6, 7). This heterogeneity may be due to differences in tumor biology such as vascularity, metabolic rate, and tumor hypoxia (8, 9).

To compare pretreatment and midtreatment tumor intensity as measured by T2 fat-saturation (T2-FS) MRI and its association with treatment response in cervical cancer patients.

Weekly MRI scans were performed for brachytherapy planning on 23 consecutive patients with clinical Stage IB1 to IIIB cervical cancer treated with definitive chemoradiotherapy. These scans were performed on a 1.5-T clinical scanner using a specialized pelvic coil. Mean signal intensity from T2-FS imaging was calculated for each tumor voxel. Average tumor intensity and tumor volume were recorded pre- and midtreatment (at Weeks 0 and 4). All patients subsequently underwent routine follow-up, including periodic clinical examinations and fluorodeoxyglucose–positron emission tomography imaging.

Mean follow-up for surviving patients was 14.5 months. Mean tumor volume at presentation was 49.6 cc, and mean midtreatment tumor volume was 16.0 cc. There was no correlation between initial tumor volume and pretreatment signal intensity (r = 0.44), nor was there a correlation between pre- or midtreatment tumor volume with disease-free survival (p = 0.18, p = 0.08 respectively.) However, having at least a 30% drop in signal intensity from pretreatment to midtreatment was correlated with having disease resolution on posttreatment fluorodeoxyglucose–positron emission tomography imaging (p = 0.05) and with disease-free survival (p = 0.03.) Estimated disease-free survival at 22 months was 100% for patients with at least a 30% drop in tumor signal intensity compared with 33% for patients above this selected threshold (p = 0.004).

Longitudinal changes in T2-FS tumor intensity during chemoradiation correlated with disease-free survival in cervical cancer patients. Persistently high midtreatment tumor intensities correlated with a high risk of treatment failure, whereas large decreases in tumor intensity correlated with a favorable outcome.

Citation Excerpt :

In our series, the para-aortic lymph node recurrence rate was relatively high (15% of patients), but always associated with synchronous pelvic recurrence or metastatic failure. Regardless of the treatment modalities, persistent pathologic pelvic or para-aortic lymph node involvement after preoperative RT with or without concurrent CT is considered to be one of the most sensitive prognostic factors (5, 18–20, 36). Extraperitoneal laparoscopic pelvic or para-aortic dissection before receiving concomitant chemotherapy (37–39) could improve selection of the treatment strategy and more accurately adopt the irradiated volume with a low risk of severe radiation-induced complications.

To evaluate toxicity, local tumor control, and survival after preoperative chemoradiation for operable bulky cervical carcinoma.

Between December 1991 and July 2006, 92 patients with operable bulky stage IB2, IIA, and IIB cervical carcinoma without pelvic or para-aortic nodes on pretreatment imaging were treated. Treatment consisted of preoperative external beam pelvic radiation therapy (EBRT) and concomitant chemotherapy (CT) during the first and fourth weeks of radiation combining 5-fluorouracil and cisplatin. The pelvic radiation dose was 40.5 Gy over 4.5 weeks. EBRT was followed by low-dose rate uterovaginal brachytherapy with a total dose of 20 Gy in 62 patients. After a median rest period of 44 days, all patients underwent Class II modified radical hysterectomy with bilateral pelvic lymphadenectomy. Thirty patients who had not received preoperative uterovaginal brachytherapy underwent postoperative low-dose-rate vaginal brachytherapy at a dose of 20 Gy. The mean follow-up was 46 months.

Pathologic residual tumor was observed in 43 patients. After multivariate analysis, additional preoperative uterovaginal brachytherapy was the single significant predictive factor for pathologic complete response rate (p = 0.019). The 2- and 5-year disease-free survival (DFS) rates were 80.4% and 72.2%, respectively. Pathologic residual cervical tumor was the single independent factor decreasing the probability of DFS (p = 0.020). Acute toxicities were moderate. Two severe ureteral complications requiring surgical intervention were observed.

Concomitant chemoradiation followed by surgery for operable bulky stage I-II cervical carcinoma without clinical lymph node involvement can be used with acceptable toxicity. Pathologic complete response increases the probability of DFS.

Objectif de l'étude. – Évaluation des résultats préliminaires en termes de toxicité, de contrôle tumoral local et de survie après une chimioradiothérapie préopératoire dans les carcinomes du col utérin de gros volume opérables.

Patientes et méthodes. – De décembre 1991 à octobre 2001, 42patientes atteintes d'un cancer du col utérin de stades IB2 (11patientes), IIA (15patientes) et IIB proximal (16patientes) ont reçu une chimioradiothérapie préopératoire. L'âge médian était de 45ans (extrêmes: 24–75ans) et la taille clinique médiane de 5cm (extrêmes: 4,1–8cm). La présence de signes radiologiques d'envahissement ganglionnaire pelvien a été observée chez dix patientes. La radiothérapie externe pelvienne a délivré 40,50Gy en 4,5semaines et était associée à une chimiothérapie par cisplatine et 5-fluoro-uracile administrée la 1^re et la 4^e semaine de radiothérapie externe pelvienne. Une curiethérapie utérovaginale de bas débit de dose de complément de 20Gy a été réalisée chez 17patientes dont l'anatomie était favorable. Après un repos de cinq à six semaines, une hystérectomie élargie non conservatrice de type Piver II avec curage ganglionnaire iliaque bilatéral a été réalisée. Un curage ganglionnaire lombo-aortique a été effectué dans huit cas, il était indemne de tumeur. Vingt et une des 25patientes qui n'avaient pu bénéficier d'une curiethérapie préopératoire ont reçu une curiethérapie vaginale postopératoire de bas débit de dose de 20Gy. Le recul médian était de 31mois (extrêmes: 3–123mois).

Résultats. – Un résidu tumoral histologique, quelle que soit sa topographie, a été observé dans 23cas. Parmi les 22patientes (52%) ayant un résidu tumoral cervical histologique (<0,5cm: 9patientes;≥0,5cm et≤1cm: 3patientes;>1cm: 10patientes), sept avaient reçu une radiothérapie externe pelvienne suivie d'une curiethérapie utérovaginale préopératoire contre 15traitées par irradiation externe pelvienne préopératoire seule (p=0,23). Un envahissement ganglionnaire pelvien histologique a été observé dans quatre cas, un résidu tumoral dans la collerette vaginale dans trois cas et paramétrial dans quatre cas. Les taux de survie globale et de survie sans rechute à deux et cinq ans étaient respectivement de 85et 74% et de 80et 71%. Après analyse multifactorielle, seule la taille du résidu cervical histologique était un facteur indépendant de la survie sans rechute (p=0,0054). Les taux de contrôle tumoral local et métastatique à cinq ans étaient respectivement de 90et 83,5%. La tolérance hématologique au cours de la chimioradiothérapie a été bonne, mais six patientes ont souffert d'une toxicité digestive aiguë de grade 3. Quatre complications sévères tardives ont nécessité une réparation chirurgicale (digestive: 1, urétérale: 3).

Conclusion. – La chimioradiothérapie suivie d'une chirurgie d'exérèse de type Piver II dans les cancers du col utérin de stades I et II de gros volume opérables est faisable avec une toxicité acceptable. Cependant, le taux de contrôle tumoral pourrait être amélioré par l'utilisation plus systématique de la curiethérapie utérovaginale de complément préopératoire.

Purpose. – To evaluate preliminary results in terms of toxicity, local tumour control, and survival after preoperative concomitant chemoradiation for operable bulky cervical carcinomas.

Patients and methods. – Between December 1991 and October 2001, 42patients (pts) with bulky cervical carcinomas stage IB2 (11pts), IIA (15pts), and IIB (16pts) with 1/3proximal parametrial invasion. Median age was 45years (range: 24–75years) and clinical median cervical tumour size was 5cm (range: 4.1–8cm). A clinical pelvic lymph node involvement has been observed in 10pts. All patients underwent preoperative external beam pelvic radiation therapy (EBPRT) and concomitant chemotherapy during the first and the fourth radiation weeks combining 5-fluorouracil and cisplatin. The pelvic dose was 40.50Gy over 4.5weeks. EBPRT was followed by low-dose-rate uterovaginal brachytherapy with a total dose of 20Gy in 17pts. After a rest period of 5–6weeks, all pts underwent class II modified radical hysterectomy with bilateral lymphadenectomy. Para-aortic lymphadenectomy was performed in eight pts without pathologic para-aortic lymph node involvement. Twenty-one of 25pts who had not received preoperative uterovaginal brachytherapy underwent postoperative low-dose-rate vaginal brachytherapy of 20Gy. The median follow-up was 31months (range: 3–123months).

Results. – Pathologic residual tumour or lymph node involvement was observed in 23pts. Among the 22pts with pathologic residual cervical tumour (<0.5 cm: nine pts;≥0.5 to≤1 cm: three pts;>1 cm: 10pts), seven underwent preoperative EBRT followed by uterovaginal brachytherapy vs. 15treated with preoperative EBRT alone (P=0.23). Four pts had pathologic lymph node involvement, three pts had vaginal residual tumour, and four pts had pathologic parametrial invasion. The 2- and 5-year overall survival rates were 85% and 74%, respectively. The 2- and 5-year disease-free survival (DFS) rates were 80% and 71%, respectively. After multivariate analysis, the pathologic residual cervical tumour size was the single independent factor decreasing the probability of DFS (P=0.0054). The 5-year local control rate and metastatic failure rate were 90% and 83.5%, respectively. Haematological effects were moderate. However, six pts had grade 3acute intestinal toxicity. Four severe late complications requiring surgical intervention were observed (one small bowel complication, three ureteral complications).

Conclusion. – Primary concomitant chemoradiation followed surgery for bulky operable stage I–II cervical carcinomas can be employed with acceptable toxicity. However, systematic preoperative uterovaginal brachytherapy should increase local tumour control.

To compare patterns and rates of early and late complications, and survival outcome in FIGO stage III cervical cancer patients underwent to radical hysterectomy after chemo-radiation (CT-RT) vs. chemo-radiation alone.

Between May 1996 and April 2013 150 FIGO stage III cervical cancer patients were treated. We divide patients according to type of treatment: 77 were submitted to standard treatment (Group A), and 73 to completion hysterectomy after chemo-radiation (Group B).

The baseline characteristics of the 2 groups were superimposable. We observed lower intra-operative and treatment-related early urinary and gastro-intestinal complications in Group B with respect to Group A (p<0.001). Vascular complications were registered only in Group B (p<0.001). We found a significantly higher rate of local recurrences in the Group A than in the Group B (p<0.002). We registered 29 deaths in the Group A and 22 in the Group B (p=0.021). The 3-years disease-free survival rate in the Group A and in the Group B was 62.9% and 68.3%, respectively (p=0.686), and the 3-years overall survival rate in the Group A and in the Group B was 63.2% and 67.7%, respectively (p=0.675).

This study confirms that radical hysterectomy after CT-RT is an effective therapeutic approach for advanced cervical cancer. Further prospective and randomized studies should be performed in order to solve the question about the standard approach, and how the different pattern of complication could impact on the quality of life.

Radical cystectomy (RC) is the standard of care for refractory high-risk non-muscle invasive bladder cancer (NMIBC). We aim to identify predictors of adequate lymph node dissection (LND) in a cohort of NMIBC patients undergoing RC, as well as its impact on clinical outcomes.

The National Cancer Database was queried for patients who underwent RC for urothelial cell carcinoma for clinical stage Tis/a/1 N0M0 disease between 2004 and 2013. Patients were stratified by LND: none, inadequate (<10) or adequate (≥10 nodes). Factors associated with LND were analyzed. Inverse-probability weighted propensity score matching was used to assess the impact of adequate LND on overall survival.

The final cohort of 3,226 patients had a median follow-up of 39.0 months, had a mean age of 65.3 years, was 70% male, and was 81% Caucasian. Overall, 16.6% received no LND, 28.5% inadequate LND, and 55.0% adequate LND. Treatment at an academic facility, Charlson-Deyo Comorbidity score of 1, and later year of treatment were significantly associated with adequate LND. Overall survival was significantly higher with adequate LND compared to a matched-cohort of inadequate LND patients (68.7% vs. 60.6% at 5 years, P < 0.01).

Nearly half of NMIBC patients undergoing RC do not receive an adequate LND, despite an association with increased overall survival. Treatment at an academic facility was associated with increased likelihood of adequate LND. Initiatives to improve adequate LND in this population may be warranted.

Extended oncologic outcomes after minimally invasive cystectomy have not been previously reported.

To report outcomes of robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC) for bladder cancer (BCa) at up to 12-yr follow-up.

All 121 patients undergoing RARC or LRC for BCa between December 1999 and September 2008 at a tertiary referral center were retrospectively evaluated from a prospectively maintained database.

RARC or LRC.

Primary end points were overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) calculated using Kaplan-Meier curves. Secondary end points were survival analysis by number of lymph nodes (LNs) and type of procedure. Surgical outcomes, including complications, were analyzed.

Most tumors were muscle invasive (≥pT2; n=81; 67%) urothelial carcinomas (n=102; 84%). Extended LN dissection was performed in 98 patients (81%), with a median of 14 nodes removed (interquartile range [IQR]: 8–18). Twenty-four patients (20%) had node-positive disease (N1: 10 [8%]; N2: 14 [12%]). Eight patients (6.6%) had positive soft tissue margins. Median follow-up was 5.5 yr (mean: 5.9; IQR: 4.2–8.2; range: 0.13–12.1). At last follow-up, 58 patients (48%) had no evidence of disease, 3 (2%) were alive with recurrence, 59 (49%) had died, and status was unknown in 1. Twenty-eight patients (23%) died from cancer-specific causes, 20 (17%) from unrelated causes, and 11 (9%) from unknown causes. The 10-yr actuarial OS, CSS, and RFS rates were 35%, 63%, and 54%, respectively. At last follow-up, OS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 67%, 73%, 53%, 50%, and 16% versus 0%, respectively (p=0.02). At last follow-up, CSS for pT0, pTis/a, pT1, pT2, and pT3 versus pT4 was 100%, 91%, 74%, 77%, and 56% versus 0%, respectively (p=0.03).

The longest oncologic outcomes following RARC and LRC for BCa reported demonstrates results similar to those reported for open RC. Continued analysis and direct randomized comparison between techniques is necessary.

L’objectif était une mise à jour des recommandations du Comité de cancérologie de l’Association française d’urologie dans la prise en charge des tumeurs de la vessie n’infiltrant pas le muscle vésical (TVNIM) et infiltrant le muscle vésical (TVIM).

Revue systématique (Medline) de la littérature de 2010 à 2013 sur les éléments du diagnostic, les options de traitement et la surveillance des TVNIM et TVIM, en évaluant les références avec leur niveau de preuve.

Le diagnostic des TVNIM (Ta, T1, CIS) repose sur la cystoscopie et une résection tumorale complète et profonde. L’utilisation de la fluorescence vésicale et l’indication d’un second look (4 à 6 semaines) contribuent à améliorer le diagnostic initial. Le risque de récidive et/ou de progression tumorale est évalué en utilisant le score EORTC. La stratification des patients en faible, intermédiaire et haut risque, permet de proposer le traitement adjuvant : instillations endovésicales de chimiothérapie (postopératoire immédiate, schéma d’attaque) ou de BCG (schéma d’attaque et d’entretien), voire l’indication d’une cystectomie, pour les patients résistant au BCG. Le bilan d’extension d’une TVIM repose sur l’examen TDM abdominopelvien et thoracique, l’IRM et le PET-FDG sont encore optionnels. La cystectomie associée à un curage ganglionnaire étendu est le traitement de référence des TVIM non métastatiques. Une entéro-cystoplastie est proposée chez l’homme et la femme en l’absence de contreindications et lorsque la recoupe urétrale est négative à l’examen extemporané, sinon l’urétérostomie cutanée transiléale est le mode de dérivation urinaire recommandé. L’intérêt de la chimiothérapie néoadjuvante est reconnu pour les TVIM de stades cliniques avancés T3-T4 et/ou N1-3. Pour les TVIM métastatiques, une première ligne de chimiothérapie à base de sels de platine (GC ou MVAC) est recommandée, si l’état général (PS >1) et la fonction rénale (clairance créat > 60ml/min) l’autorisent (50 % seulement des cas). En deuxième ligne de traitement, seule l’indication de la vinfluvine est aujourd’hui validée.

Ces nouvelles recommandations doivent contribuer à améliorer non seulement la prise en charge des patients, mais aussi le diagnostic et la décision thérapeutique des TVNIM et TVIM.

The objective was to update the guidelines of the French Urological Association Cancer Committee for non invasive (NMIBC) and invasive bladder cancer (MIBC).

A Medline search was performed between 2010 and 2013, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.

Diagnosis of NMIBC (Ta, T1, CIS) depends on cystoscopy and complete deep resection of the tumour. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on pelvic-abdominal and thoracic CT-scan, MRI and FDGPET remain optional. Cystectomy associated with extensive lymph nodes resection is considered the gold standard for non metastatic MIBC. An orthotopic bladder substitution should be proposed to both male and female patients lacking any contraindications and in cases of negative frozen urethral samples, otherwise trans-ileal ureterostomy is recommended as urinary diversion. The interest of neoadjuvant chemotherapy is well known for advanced MIBC as T3-T4 and/or N1-3. As regards metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when status (PS<1) and renal function (creatinine clearance > 60ml/min) permits (only in 50 % of cases). In second line treatment, only chemotherapy using vinfluvine has been validated to date. Conclusion.-These new guidelines will hopefully contribute not only to improve patient management, but also diagnosis and treatment for NMIBC and MIBC.

We evaluated the 6-month postpartum risk of metabolic syndrome (MetS), a marker of future cardiovascular disease (CVD) risk, comparing women whose most recent pregnancies were complicated with gestational hypertension (GH) or preeclampsia (PE) versus those who had normotensive pregnancies.

This was a prospective cohort study in which women with GH or PE and normotensive women were actively enrolled during the first 12 weeks after delivery in Nairobi, Kenya. Participants were interviewed, blood pressures and anthropometric measurements including waist circumference obtained at enrollment and 6 months postpartum. Fasting lipid profile and plasma glucose were measured at 6 months postpartum. A generalized linear regression model with Poisson distribution was used to estimate crude relative risk (RR) of 6-month postpartum MetS and adjusted RR (ARR) after adjusting for apriori potential confounders.

Among 194 postpartum women, 63 (32%) had experienced GH or PE. Prevalence of MetS at 6 months postpartum was higher among women whose pregnancies were complicated with GH or PE (34.9%) compared to those who were normotensive (11.5%). GH and PE were associated with a 3-fold or greater risk of MetS (ARR) 3.01; 95% Confidence interval [CI] 1.58, 5.71; p < 0.001) overall and three of the five components, namely hypertension (ARR 3.35 [2.04, 5.51], p < 0.001), hypertriglyceridemia (ARR 3.25 [1.16–9.10], p = 0.01), and fasting hyperglycemia (ARR 6.20 [1.07–35.76], p = 0.03), compared to having normal blood pressures during pregnancy.

At 6  months postpartum, GH and PE were associated with three-fold or higher risk of MetS and especially hypertension, fasting hypertriglyceridemia, and fasting hyperglycemia.