Management and prognostic factors of epithelioid trophoblastic tumors: Results from the International Society for the Study of Trophoblastic Diseases database

Frijstein, Minke; Lok, Christianne; Trommel, Nienke E. van; Kate‐Booij, Marianne J. ten; Massuger, Leon F.A.G.; Werkhoven, Erik van; Kaur, Baljeet; Tidy, John; Sarwar, Naveed; Golfier, François; Winter, M.C.; Hancock, Barry W.; Seckl, Michael J.; database, Ett

doi:10.1016/j.ygyno.2018.11.015

Cited by 47 publications

(76 citation statements)

References 14 publications

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“…Data are currently being collected in a global database of PSTTs and ETTs through the efforts of the International Society for the Study of Trophoblastic Disease. 10,[123][124][125][126][127][128] ITTs can be differentiated from other types of GTN via their histopathologic characteristics. 10 In PSTT, immunohistochemical staining reveals the diffuse presence of cytokeratin, Mel-CAM, and human placental lactogen (hPL), whereas hCG staining is only focal.…”

Section: Intermediate Trophoblastic Tumorsmentioning

confidence: 99%

“…The most important prognostic factors include advanced disease stage and interval from last known pregnancy event of $48 months. 124,127,128,134 Additional risk factors associated with less favorable outcomes are advancing age, deep myometrial invasion, tumor necrosis, large tumor size, and mitotic index. 10,128,135 Treatment Approach ITTs are relatively chemoresistant and thus follow a somewhat different treatment paradigm than invasive mole and choriocarcinoma, with surgical intervention playing a more critical role.…”

Section: Intermediate Trophoblastic Tumorsmentioning

confidence: 99%

“…Increased use of platinum-based chemotherapy and HDC over time has led to improved overall survival for the subset of patients with ITT who have an overall poor prognosis (ie, interval $48 months from last known pregnancy event). 124,[126][127][128]…”

Section: Intermediate Trophoblastic Tumorsmentioning

confidence: 99%

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Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum

Yashar

Bean

et al. 2019

Journal of the National Comprehensive Cancer Network

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Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.

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Section: Intermediate Trophoblastic Tumorsmentioning

confidence: 99%

Section: Intermediate Trophoblastic Tumorsmentioning

confidence: 99%

See 1 more Smart Citation

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum

Yashar

Bean

et al. 2019

Journal of the National Comprehensive Cancer Network

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“…PSTT and ETT are derived from intermediate trophoblast, therefore, hCG levels in patients with these 2 rare types of GTN are often normal or only mildly elevated. Horowitz et al reported that hCG levels were <1,000 IU/L in most patients with PSTT and ETT, while high hCG levels (>10,000 IU/L) were often found in patients with choriocarcinoma (3, 20). Among previously reported patients with mixed GTN as well as those in our series, the majority had markedly elevated hCG levels (>10,000 IU/L); such patients are more likely to be suspected of having choriocarcinoma on initial clinical presentation before pathological evidence becomes available.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Mixed Gestational Trophoblastic Neoplasia: A Study of 16 Cases and a Review of the Literature

et al. 2019

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Objective: Mixed gestational trophoblastic neoplasia (GTN) is a rare occurrence that refers to the coexistence of choriocarcinoma and/or placental site trophoblastic tumor and/or epithelioid trophoblastic tumor. The diagnosis and management of mixed GTN are challenging. We investigated the clinicopathological characteristics, diagnoses, treatments, and outcomes of patients with mixed GTN.Materials and Methods: The medical records and pathological sections of 16 patients with mixed GTN who were treated at Peking Union Medical College Hospital and The Second Xiangya Hospital of Central South University between January 2012 and December 2018 were reviewed.Results: Pretreatment serum human chorionic gonadotropin (hCG) levels ranged from 180 to 625,024 IU/L, and were >10,000 IU/L in 14 of the 16 patients, none of whom were diagnosed correctly at initial presentation. Two patients were diagnosed with choriocarcinoma coexisting with intermediate trophoblastic tumor (ITT) through dilation and curettage (D&C) before treatment. Another 5 patients were histologically confirmed to have placental site trophoblastic tumor (PSTT) by D&C but final pathological findings showed mixed PSTT and choriocarcinoma at subsequent hysterectomy. Seven post-chemotherapy patients with an initial clinical diagnosis of choriocarcinoma underwent surgery because of chemoresistance and their pathological findings revealed coexisting ITT. The remaining 2 patients were found to have choriocarcinoma coexisting with ITT following cervical biopsy and pulmonary lobectomy. All patients received chemotherapy: 14 underwent surgery combined with chemotherapy and 2 received chemotherapy alone to preserve fertility. Other than 1 patient who died of disease progression, 15 patients (93.8%) achieved complete remission (CR) after treatment, although 5 (33.3%) relapsed. Of these 5 patients with relapse, 3 achieved CR after additional treatment, 1 was receiving an immune checkpoint inhibitor, and 1 was lost to follow-up after refusing further therapy.Conclusion: Mixed GTN is difficult to diagnose on initial presentation. Overlap of the ITT component should be considered in refractory chemoresistant choriocarcinoma. Coexistence of choriocarcinoma should be suspected in ITT patients with high hCG levels. Surgery combined with chemotherapy is optimal treatment for choriocarcinoma mixed with ITT.

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“…Around two thirds of the patients with PSTT present with disease localised to uterus, with reported long-term survival rates ranging from 90% to 100% with hysterectomy alone [ 54 ]. In a recent largest series including 54 patients with ETT or mixed PSTT/ETT, two thirds of the patients had FIGO stage I disease, of which all patients who underwent surgery only survived, compared to 71% in patients who underwent combination of surgery and chemotherapy [ 56 ]. Four deaths in stage I disease occurred in patients with an interval of ≥48 months since the antecedent pregnancy (1 interval unknown) which is a poor prognostic factor of ETT.…”

Section: Surgery For Malignant Gestational Trophoblastic Neoplasiamentioning

confidence: 99%

Surgery including fertility-sparing treatment of GTD

Ngu

Ngan

2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Gestational trophoblastic disease (GTD) consist of a spectrum of diseases, including hydatidiform moles, invasive mole, metastatic mole, choriocarcinoma, placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT). GTD are relatively uncommon disease occurring in women of reproductive age, with high cure rates. Primary treatment of hydatidiform moles includes uterine evacuation, followed by close monitoring of serial hCG levels to detect for post-molar gestational trophoblastic neoplasia (GTN). In patients with GTN, the main therapy consists of chemotherapy, although some surgical procedures are important in selected patients in order to achieve cure. Hysterectomy is the mainstay treatment for PSTT or ETT, and may be considered in selected patients for management of hydatidiform mole and malignant GTN especially in chemoresistant disease. Resection of metastatic lesions such as in the lung or brain can be considered in selected patients with isolated chemoresistant tumour. Surgical treatment of GTD will be discussed in this chapter.

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Management and prognostic factors of epithelioid trophoblastic tumors: Results from the International Society for the Study of Trophoblastic Diseases database

Cited by 47 publications

References 14 publications

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Diagnosis and Management of Mixed Gestational Trophoblastic Neoplasia: A Study of 16 Cases and a Review of the Literature

Surgery including fertility-sparing treatment of GTD

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