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Background Placental-site trophoblastic (PSTT) and epithelioid trophoblastic tumours (ETT) are the rarest malignant forms of gestational trophoblastic disease (GTD). Our prior work demonstrated that an interval of ≥48 months from the antecedent pregnancy was associated with 100% death rate, independent of the stage. Here, we assess whether modified treatments for these patients have increased survival and identify new prognostic factors. Methods The United Kingdom GTD database was screened to identify all PSTT/ETT cases diagnosed between 1973 and 2014. Data and survival outcomes from our prior patient cohort (1976–2006) were compared to our new modern cohort (2007–2014), when intensified treatments were introduced. Results Of 54,743 GTD patients, 125 (0.23%) were diagnosed with PSTT and/or ETT. Probability of survival at 5 and 10 years following treatment was 80% (95% CI 72.8–87.6%) and 75% (95% CI 66.3–84.3%), respectively. Univariate analysis identified five prognostic factors for reduced overall survival (age, FIGO stage, time since antecedent pregnancy, hCG level, mitotic index) of which stage IV disease (HR 6.18, 95% CI 1.61–23.81, p  = 0.008) and interval ≥48 months since antecedent pregnancy (HR 14.57, 95% CI 4.17–50.96, p  < 0.001) were most significant on multivariable analysis. No significant differences in prognostic factors were seen between the old and new patient cohort. However, the new cohort received significantly more cisplatin-based and high-dose chemotherapy, and patients with an interval ≥48 months demonstrated an improved median overall survival (8.3 years, 95% CI 1.53–15.1, versus 2.6 years, 95% CI 0.73–4.44, p  = 0.·005). Conclusion PSTT/ETT with advanced FIGO stage or an interval ≥48 months from their last known pregnancy have poorer outcomes. Platinum-based and high-dose chemotherapy may help to improve survival in poor-prognosis patients.

Placental-site trophoblastic tumours are a rare form of gestational trophoblastic disease and consequently information about optimum management or prognostic factors is restricted. We aimed to assess the long-term outcome of stage-adapted management by surgery, chemotherapy, or both for patients with the disorder. 35 550 women were registered with gestational trophoblastic disease in the UK (1976–2006), of whom 62 were diagnosed with placental-site trophoblastic tumours and included, retrospectively, in the study. Patients were treated by surgery, chemotherapy, or both. We estimated the probabilities of overall survival and survival without recurrence of disease 5 and 10 years after the date of first treatment, and calculated the association of these endpoints with prognostic factors, including time since antecedent pregnancy, serum concentration of β-human chorionic gonadotropin, and stage of disease, with both univariate and multivariate analyses. Probabilities of overall and recurrence-free survival 10 years after first treatment were 70% (95% CI 54–82) and 73% (54–85), respectively. Patients with stage I disease had a 10-year probability of overall survival of 90% (77–100) and did not benefit from postoperative chemotherapy. By contrast, patients with stage II, III, and IV disease required combined treatment with surgery and chemotherapy; probability of overall survival at 10 years was 52% (3–100) for patients with stage II disease and 49% (26–72) for stage III or IV disease. Outcome for patients who had recurrent or refractory disease was poor: only four (22%) patients achieved long-term survival beyond 60 months. Multivariate analysis showed that the only significant independent predictor of overall and recurrence-free survival was time since antecedent pregnancy. A cutoff point of 48 months since antecedent pregnancy could differentiate between patients' probability of survival (<48 months) or death (≥48 months) with 93% specificity and 100% sensitivity, and with a positive predictive value of 100% and a negative predictive value of 98%. Stage-adapted management with surgery for stage I disease, and combined surgery and chemotherapy for stage II, III, and IV disease could improve the effectiveness of treatment for placental-site trophoblastic tumours. Use of 48 months since antecedent pregnancy as a prognostic indicator of survival could help select patients for risk-adapted treatment. National Commissioning Group.

Opinion statement Placental site trophoblastic tumor (PSTT) is the least common and the most ambiguous gestational trophoblastic tumor. Presentation of PSTT may occur in the course of gestation or from 1 week to 14 years after a normal or an abnormal pregnancy (mole, ectopic pregnancy, abortion). The indicators of aggressive behavior for this tumor are not well established. Due to the rarity of this disease that usually affects women of childbearing potential, we aimed to review the current literature, to identify risk factors and the best conservative therapeutic choices among the cases described. We performed a systematic literature search of articles in English language, published from 1996 to 2017 and indexed in PubMed and Scopus. Based on selective inclusion/exclusion criteria, we considered eight papers eligible for the review. Five were case reports and three were retrospective studies. We extracted and organized data into three different categories depending on the main treatment used. A total of 12 cases were treated with laparotomy; in 5 cases, the treatment was not curative. Therefore, a total abdominal hysterectomy was needed. Five cases were treated successfully with a minimally invasive approach, 2 with uterine evacuation, 2 with hysteroscopic resection, and 1 with a combined hysteroscopic/laparoscopic resection. Only 1 case treated with exclusive chemotherapy proved curative for the patient. Preservation of fertility in PSTT patients of childbearing age should be considered and as showed by the abovementioned studies, is a possible and safe therapeutic choice. Laparotomy for local uterine resection with the modified Strassman approach could be offered in patients at clinical stage 1 that are very motivated to retain fertility, extensively informing the patient of the risks and benefits related to this choice.

Placental site trophoblastic tumor (PSTT) is a rare variant of gestational trophoblastic disease that originates from the implantation site intermediate trophoblast. We report four patients with PSTT and review pertinent literature. Three patients presented with disease confined to the uterus and one patient with disease extension beyond the uterus. Antecedent pregnancy was full-term pregnancy in three patients and termination of a 21-week pregnancy in one patient. Interval from the antecedent pregnancy was <1 year in three patients and 13 years in one patient. Primary treatment was simple hysterectomy in three patients and radical hysterectomy in one patient. Overall, three patients received chemotherapy; one had EP/EMA as adjuvant chemotherapy, one had EMA/CO for rising levels of serum β-hCG and one had BEP then VIP for recurrent disease. The three patients with disease confined to the uterus have remained after treatment alive and with no evidence of disease, whereas the one patient with disease extension beyond the uterus died of disease despite surgery and aggressive chemotherapy. It is concluded that disease extension beyond the uterus is the most important adverse prognostic factor. Other adverse prognostic factors are interval from antecedent pregnancy >2 years, age >40 years, and mitotic count >5 mitotic figures/10 high-power fields. Because of the relative insensitivity to chemotherapy, hysterectomy is the mainstay of treatment. EP/EMA seems to be the most effective first-line chemotherapy available to date for metastatic and relapsing PSTT

IntroductionPlacental site trophoblastic tumour (PSTT) is a rare type of gestational trophoblastic malignancy. Despite different guidelines recommending surgery, chemotherapy or immunotherapy, there has been no optimal first-line treatment owing to its rarity. Direct comparisons of efficacy and safety across interventions remain limited. We aim to perform a systematic review and network meta-analysis (NMA) to explore each PSTT treatment and to help develop individualised, evidence-based clinical decisions.Methods and analysisThis systematic review, registered on PROSPERO and adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-P 2015 guidelines, will evaluate all available treatments for PSTT. Databases (PubMed, Scopus, Embase, Web of Science) will be searched from inception to 31 May 2025 using Medical Subject Headings terms and keywords related to PSTT. The inclusion criteria will be studies reporting confirmed PSTT patients and treatment outcomes; the exclusion criteria will be non-human studies, abstracts and reviews. Two researchers will independently screen studies, resolving discrepancies via discussion or a third reviewer. Manual reference checks will complement searches. Data on study characteristics, interventions (chemotherapy, surgery or other treatments) and outcomes (overall survival (OS), progression-free survival, adverse events, fertility) will be extracted. The primary outcome will be the OS. Quality will be assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and V.2 Cochrane Risk of Bias Assessment Tool (RoB 2) for randomised controlled trials. Statistical analyses will be conducted via Review Manager 5.4.1 and Stata 16.0. The ORs, along with 95% CIs will be calculated with random-effects or fixed-effects models depending on the heterogeneity between studies. The sensitivity analyses and publication bias (funnel plots, Begg’s/Egger’s tests) will be assessed if indicated.Ethics and disseminationAs this study analyses previously published data, no additional ethical approval is required, nor will patient safety be compromised. The collected results will be submitted for publication in a peer-reviewed journal following PRISMA-NMA guidelines. No datasets will be generated or analysed during the current study.PROSPERO registration numberCRD420251013082.

ObjectiveTo investigate the methods of fertility-sparing therapy for patients with placental site trophoblastic tumor (PSTT) and analyze the outcomes.MethodsFrom January 1999 to October 2010, the clinical features, pathology, diagnosis, fertility-preserving treatment, and outcomes of 6 patients with PSTT were studied retrospectively. Six patients were provided with multimodality treatment, which combined with surgery and chemotherapy. Five patients had received intrauterine arterial infusion chemotherapy. Three patients with polypoid-type tumor were treated by dilation and curettage and combination chemotherapy. Three patients with nodular masses underwent uterine tumor resection and combination chemotherapy. Two patients with nodular masses were treated by combination chemotherapy after dilation and curettage, and then uterine tumor resection was performed.ResultsAfter follow-up for 10 to 104 months (mean, 47 months), 6 patients achieved a complete remission, presented no signs of recurrence, and had restored normal menstruation. One of them had a normal delivery in July 2011.ConclusionsFertility-conserving therapy for young women with PSTT would be practicable if the patient is younger than 35 years, strongly desires to preserve fertility and responds well to chemotherapy and conservative surgery, the pathological results of which do not show poor prognostic factors and the gross pathologic type does not present markedly enlarged uterus, diffuse infiltrative and diffuse multifocal disease within the uterus.

Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease accounting for about 1%–2% of all trophoblastic tumours. Diagnosis and management of placental site trophoblastic tumour can be difficult.We report a case of a 30-year-old woman diagnosed with a placental site trophoblastic tumour and identify the challenges in diagnosis and treatment of this rare situation. The presenting sign was abnormal vaginal bleeding that started 3 months after delivery. Image exams revealed an enlarged uterus with a heterogeneous mass, with vesicular pattern, and the increased vascularisation serum human chorionic gonadotropin level was above normal range. The histological diagnosis was achieved through hysteroscopic biopsy. Staging exams revealed pulmonary micronodules. The patient was successfully treated with hysterectomy and chemotherapy. The latest follow-up (37 months after diagnosis) was uneventful, and the patient exhibited no signs of recurrence or metastasis.

Compiles information on pathways for diagnosis and management of molar pregnancy/gestational trophoblastic disease (GTD) across NZ, and the protocols used. Considers the views of obstetrician and gynaecologist specialists on a national GTD reference centre. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Placental-site trophoblastic tumors (PSTTs) are often resistant to chemotherapy and have a high incidence of lung metastasis. Cole et al . report the case of a 52-year-old woman who was diagnosed with metastatic chemoresistant PSTT. The patient was managed with abdominal hysterectomy, salpingo-oophrectomy, radiotherapy, chemotherapy, and thoracotomy with wedge resection. The authors discuss the treatment options for patients with PSTTs, especially for those with persistent metastatic disease. Background A 52-year-old woman whose last known pregnancy was 12 years before presentation was diagnosed with mixed trophoblastic tumor that included placental-site trophoblastic tumor, epithelioid trophoblastic tumor, and focal choriocarcinoma. There was no clear evidence of metastatic disease on initial evaluation. Investigations Histopathology, laboratory tests, immunohistochemistry, chest X-ray, CT scan of the chest, abdomen, and pelvis, fine-needle aspiration biopsy, PET-CT scan. Diagnosis Metastatic chemoresistant placental-site trophoblastic tumor positive for EGFR, VEGF receptor, and platelet-derived growth factor receptor. Management Abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic radiation, etoposide, methotrexate, actinomycin D/cyclophosphamide and vincristine chemotherapy, left thoracotomy with wedge resection, taxol, etoposide, cisplatin therapy, right thoracotomy with wedge resection.