Alexander AL, Strohl AE, Maniar KP, Lurain JR. Placental site trophoblastic tumor: Successful treatment of 13 cases.
Gynecol Oncol Rep 2020;
32:100548. [PMID:
32274412 PMCID:
PMC7132153 DOI:
10.1016/j.gore.2020.100548]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022] Open
Abstract
Extent of disease (stage) is the most important predictor of prognosis in PSTT.
Prolonged interval from pregnancy to diagnosis of PSTT is an adverse prognostic indicator.
Pathologic high-risk features of PSTT are deep invasion, tumor necrosis, and high mitotic rate.
Surgery is the most important component in the treatment of PSTT.
Platinum/etoposide-containing chemotherapy should be used for high-risk PSTT.
Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic neoplasia (GTN) that is characterized by slow growth resulting in mostly uterine-confined disease, low human chorionic gonadotropin (hCG) levels, and resistance to chemotherapy.
Our objective was to update our center’s experience with PSTT with respect to presentation, prognostic factors, treatment, and outcomes from 2003 to 2019.
Thirteen women with PSTT were identified. Mean age was 32 years. The most frequent presenting symptom was abnormal uterine bleeding (69%). A uterine mass was noted in 62%. The diagnosis was usually established by endometrial biopsy or curettage (62%). Nonmolar pregnancy was the preceding gestation in 85%. Median time from last pregnancy to diagnosis was 13 months (range 0–240 months). Serum hCG levels at diagnosis ranged from 1 to 2606 mIU/mL (median 98 mIU/mL). Three women (23%) presented with metastatic disease. All 13 women underwent surgery: 12 had a hysterectomy, 1 had a fertility-sparing hysteroscopic resection, and 2 underwent pulmonary metastatectomy. Nine women (69%) also received chemotherapy for persistently elevated hCG levels after hysterectomy (2), high-risk factors (4), or metastatic disease (3). Overall survival was 100% with a median survival of 65 months (range 30–167 months).
Survival for PSTT increased from 57% to 100%, including from 33% to 100% for metastatic disease, at our center from 1982 to 2003 to 2003–2017. Surgery is the most important component in the treatment of women with PSTT. Multidrug platinum/etoposide- chemotherapy should be used in women with metastatic disease and considered in women with nonmetastatic disease with high-risk features.
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