目的:分析方法,可行性,效率,胎盘部位滋养细胞肿瘤(PSTT)患者的保留生育治疗和生育结局。
方法:回顾性收集1998年4月至2020年4月北京协和医院(PUMCH)确诊的PSTT患者的临床资料。临床特征,治疗,对接受保留生育功能治疗的患者的结局进行分析,并与接受子宫切除术的患者进行比较.
结果:总计,126名患者被纳入研究,其中29名患者接受了保留生育能力的治疗。与子宫切除术组相比,保留生育力组的年龄明显较小,足月分娩比例较低,在阶段没有观察到显著差异,血清β-hCG水平,或两组之间的前妊娠间隔。保守手术选择个体化,均未进行挽救性子宫切除术。有临床或病理高危因素的患者接受辅助化疗,然而,保留生育力的治疗并未显著延长化疗持续时间.保留生育力组的所有患者在随访36至176个月后均达到完全缓解而无复发,并且在治疗后一年以上有16例健康足月分娩。
结论:对于强烈希望保留其生育潜力的患有局部子宫病变的年轻患者,可以考虑对PSTT进行生育保护治疗。采用个体化保守手术和选择性辅助化疗,保留生育力的治疗不会影响复发风险或总体生存率,患者将获得良好的妊娠和活产结局.
To analyze the methods, feasibility, efficiency, and fertility outcomes of fertility-sparing treatment for patients with placental site trophoblastic tumor (PSTT).
Clinical data of patients diagnosed with PSTT between April 1998 and April 2020 from Peking Union Medical College Hospital (PUMCH) were retrospectively collected. The clinical features, treatment, and outcomes of patients received fertility-sparing treatment were analyzed and compared with patients suffered hysterectomy.
In total, 126 patients were included in the study and 29 of them received fertility-sparing treatment. Besides significantly younger age and lower proportion of antecedent term delivery were seen in fertility-sparing group than hysterectomy group, no significant differences were observed in stage, serum β-hCG level, or interval from antecedent pregnancy between the two groups. Conservative surgery was selected individualized and none of them suffered salvage hysterectomy. Patients with clinical or pathological high-risk factors received adjuvant chemotherapy, yet the fertility-sparing treatment did not significantly lengthen chemotherapy duration. All patients in fertility-sparing group achieved complete remission without relapse after 36 to 176 months of follow-up and had sixteen healthy term delivery more than one year after the treatment.
Fertility-sparing treatment for PSTT can be considered for young patients with localized uterine lesions who strongly desire to preserve their fertility potential. With individualized conservative surgery and selected adjuvant chemotherapy, fertility-sparing treatment will not influence the risk of relapse or overall survival and patients will achieve favorable pregnancy and live birth outcomes.