Conservative surgery in stage I placental site trophoblastic tumor: a report of 10 cases and literature review

Background and purpose: Placental site trophoblastic tumor (PSTT) is a rare type of malignant tumor. Because of its unique mode of invasion in the uterus and its insensitivity to chemotherapy, total hysterectomy is the primary recommendation. The purpose of this study was to investigate the feasibility and safety of conservative surgical treatment in patients with stage Ⅰ PSTT. Methods: The patients with stage Ⅰ PSTT admitted to Obstetrics and Gynecology Hospital of Fudan University from January 2015 to December 2021 were included, and those published on Pubmed and China National Knowledge Infrastructure (CNKI) from January 1990 to December 2021 were searched with the keywords of “placental site trophoblastic tumor” and “case”, “placental trophoblastic tumor” and “case” respectively. The clinicopathological data of the patients were collected and retrospectively analyzed. Results: A total of 10 cases admitted to Obstetrics and Gynecology Hospital of Fudan University were enrolled. The median age was 27 years. The most common symptom was irregular vaginal bleeding (70.0%). The median time of interval since antecedent pregnancy (ISAP) was 14.5 months. The median level of β-human chorionic gonadotrophin (β-hCG) was 124.51 mU/mL, and the diameter of the focus was 0.8-8.0 cm. All 10 patients admitted to Obstetrics and Gynecology Hospital of Fudan University achieved complete remission after initial treatment. The average follow-up time was 48.1 months and there was no recurrence. Three patients became pregnant naturally after treatment, including 2 cases of full-term pregnancy and delivery and 1 case of induced abortion because of unplanned pregnancy. Literature review of PSTT cases showed similar clinicopathological distribution and disease outcome. Conclusion: Conservative surgery could be an alternative choice for selected patients with stage Ⅰ PSTT, but more research is needed to provide evidence.