Prognostic factors and treatment for placental site trophoblastic tumor - Report of 3 cases and analysis of 88 cases

Objective. In order to understand the prognostic factors of placental site trophoblastic tumors (PSTT), we performed a MEDLINE search for cases from 1 976 through 1998 and report three cases. Materials and Methods. The patients' age at presentation, antecedent pregna ncies, and responses to treatment were analyzed according to the extent of disease, disease status after treatment, and survival in 88 cases. Results. Patients with disease extending outside the uterus at presentation had a median latency of 24 months between the antecedent pregnancy and pre sentation of PSTT, which was significantly longer than that of 12 months in those with disease confined to the uterus, Patients with metastatic diseas es were 3 years older than patients with diseases confined to the uterus an d had a higher incidence of term delivery as their antecedent pregnancy. Th e outcomes of patients with FIGO stage I-II disease after hysterectomy were excellent, while those with FIGO stage III-IV diseases had a 30% survival. Although initial partial responses to chemotherapy were observed in some p atients, only 5 patients achieved a complete remission and 3 of these 5 rec eived a combination of etoposide, methotrexate, and actinomycin-D, alternat ing with cyclophosphamide and vincristine. Conclusion. FIGO stage is the most important prognostic factor, and complet e removal of all lesions provided good outcomes in PSTT patients. For those with unresectable tumors, combination chemotherapy showed a high response rate, but only a few achieved a complete response. (C) 1999 Academic Press.