title: Placental site trophoblastic tumor: A review of 108 cases and their implications for prognosis and treatment.
abstract: OBJECTIVE
  To identify important prognostic factors and optimized treatment strategies through the analysis of the clinical and pathological characteristics of placental site trophoblastic tumor.
  
  
  METHODS
  108 patients with PSTT registered in two GTD centers or in six tertiary hospitals in China were analyzed retrospectively between the years 1998 and 2013. The computerized database of clinical and pathological reports was reviewed on this patient group. The data were subsequently analyzed retrospectively using SPSS software.
  
  
  RESULTS
  Among 3581 patients with GTNs treated in GTD centers or in the tertiary hospitals between 1998 and 2013, 108 cases were histologically confirmed PSTT (3%). Only seven deaths and eleven relapse cases were observed. All seven of the deaths were disease related, due to chemotherapy-resistant or relapsed. 23 patients who received fertility preservation treatment did not experience poor outcome or high risk of relapse. In 71 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I disease, the use of adjuvant chemotherapy following surgery (n=49) or not (n=22) made no significant difference in relapse rate (P=0.303) or survival (P=0.782). Univariate analysis revealed the interval between antecedent pregnancy and onset of PSTT, stage, prognosis score, and necrosis as significant predictors of poor survival but only stage remained significant on multivariate analysis.
  
  
  CONCLUSIONS
  Patients with FIGO stage IV disease demonstrate the most critical risk indicator of PSTT in the current study. Preservation of fertility is considered in highly-selected patients with localized tumor; and surgery without chemotherapy is recommended as first line treatment for patients with stage I who are at low-risk.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: W G
authors.initials: WG
authors.lastname: Lv
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
authors.forename: F Z
authors.initials: FZ
authors.lastname: Feng
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
authors.forename: X R
authors.initials: XR
authors.lastname: Wan
authors.affiliation: Department of Obstetrics and Gynecology, Cancer Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: J H
authors.initials: JH
authors.lastname: Liu
authors.affiliation: Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai, China.
authors.forename: X F
authors.initials: XF
authors.lastname: Yi
authors.affiliation: Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
authors.forename: P P
authors.initials: PP
authors.lastname: Qu
authors.affiliation: Department of Obstetrics and Gynecology, General hospital, Tianjin Medical University, Tianjin, China.
authors.forename: F X
authors.initials: FX
authors.lastname: Xue
authors.affiliation: Department of Cancer, Affiliated Beijing Obstetrics and Gynecology Hospital, Affiliated Capital University of Medical Sciences, Beijing, China.
authors.forename: Y M
authors.initials: YM
authors.lastname: Wu
authors.affiliation: Department of Gynecology and Obstetrics, West China Second Hospital, West China Medical School of Sichuan University, Chengdu, China.
authors.forename: X
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
authors.forename: T
authors.initials: T
authors.lastname: Ren
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
authors.forename: J J
authors.initials: JJ
authors.lastname: Yang
authors.affiliation: Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: X
authors.initials: X
authors.lastname: Xie
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China. Electronic address: xiangy@pumch.cn.
authors.forename: Y
authors.initials: Y
authors.lastname: Xiang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D018245:Trophoblastic Tumor, Placental Site / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
keywords: Fertility preservation; Placental site trophoblastic tumor; Prognosis; Treatment