Fertility-sparing treatment in patients with placental trophoblastic site tumor: a systematic review

Abstract

Objective: Placental site trophoblastic tumor (PSTT) is a rare pathologic entity of gestational trophoblastic neoplasia. The main objective of the present manuscript is to summarize current evidence regarding the possibility of fertility-sparing management.

Methods: A systematic review of the literature was conducted to evaluate the efficacy, oncological safety, and fertility-preservation outcomes in patients with PSTT undergoing fertility-sparing management. PubMed, Scopus, and Cochrane Library were searched to identify proper articles. Eligibility criteria included all prospective or retrospective cohorts reporting conservative management of PSTT. Primary outcomes were the rate of recurrence and fertility outcome. Secondary outcomes concerned the type of conservative management.

Results: Overall, 16 articles were retrieved including a total of 63 patients. The mean age was 28.3 years (range; 21-37) and the mean serum beta-human chorionic gonadotropin was 17,251.9 IU/L (range; <0.1 to 430,290 IU/L). Regarding the antecedent pregnancy, 41.3% (26 cases) were full-term pregnancies, and 30.2% (19 cases) were abortions. Most cases were International Federation of Gynecology and Obstetrics stage I (73%). The overall recurrence rate of disease was 13.8% (8 of 63 patients) with these patients all treated with hysterectomy after recurrence. There were overall 23 full-term pregnancies reported, indicating a 36.5% fertility rate per patient, while 2 pregnancies are still ongoing at the time of publication.

Conclusions: Fertility-sparing management of patients with PSTT is feasible and oncologically safe, with 36.5% fertility outcomes.

Keywords: Conservative Surgical Treatment; Fertility Preservation; Fertility Sparing; Gestational Trophoblastic Neoplasia; PSTT; Placental Site Trophoblastic Tumor; Post-Treatment Pregnancy.