{"id":293,"title":"De-escalation strategies and fertility preservation in Stage I placental site trophoblastic tumor: an individual patient data systematic review and institutional series","title_zh":"I期胎盘部位滋养细胞肿瘤的降阶梯治疗与生育力保存：个体患者数据系统评价及单中心系列","url":"https://pubmed.ncbi.nlm.nih.gov/42981794","doi":"10.1016/j.ygyno.2026.10.028","pmid":"42981794","journal":"Gynecol Oncol","kind":"paper","lang":"en","published_at":"2026-11-04T00:00:00+00:00","fetched_at":"2026-11-08T03:44:04+00:00","authors":["Chen J","Zhu G","Sun Y","Yu H","Ma F","Tao X","Zhu T","Chen T","Cheng Y","Lu X"],"primary_topic":"endometrium","topics":[{"slug":"endometrium","score":3.0,"hits":["placental"]},{"slug":"fertility-preservation","score":3.0,"hits":["fertility preservation"]},{"slug":"contraception-health","score":1.0,"hits":["childbearing"]},{"slug":"ethics-policy","score":1.0,"hits":["guidelines"]}],"topic_score":3.0,"preference_score":0.0,"preference_labels":[],"llm_score":78.0,"final_score":78.0,"score_dims":{"novelty":76,"rigor":82,"impact":72,"relevance":68,"translation":76},"recommend_reason":"为I期PSTT的化疗省略与保留生育手术提供了较大样本的个体数据证据，直接支持临床降阶梯决策；但为回顾性队列与文献整合，仍需前瞻性验证。","keywords":["胎盘部位滋养细胞肿瘤","降阶梯治疗","生育力保存","ISAP","化疗省略","保留生育手术"],"selected":1,"story_id":80,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-endo-genetics","source_name":"PubMed · 生殖内分泌/遗传/保存","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"该研究整合单中心36例与1990–2021年文献193例，共229例I期胎盘部位滋养细胞肿瘤患者，采用多重插补和多因素Cox回归评估ISAP截断值及预后因素。结果显示ISAP≥48个月为稳健高危界值，独立预测无进展生存和总生存；传统病理危险因素无预后意义。低危未化疗者无进展或死亡（0/85）；保留生育手术者8.0%需补救性子宫切除，生存率100%，生育后无需补充子宫切除。结论提示低危患者或可安全省略化疗，保留生育手术在严格选择者中可行。","summary":"OBJECTIVE: This study evaluates the statistical robustness of the ISAP cutoff proposed by the 2025 guidelines, re-assesses traditional pathological prognostic factors, and identifies candidates for therapeutic de-escalation regarding chemotherapy omission and fertility-sparing surgery (FSS). METHODS: We harmonized an institutional cohort (2015-2021, N = 36) with a systematic literature review (1990-2021, N = 193). Missing data were handled via multiple imputation. The optimal ISAP cutoff was determined using AIC/BIC; prognostic factors were evaluated via multivariate Cox regression. RESULTS: Among 229 patients (50 [21.8%] undergoing FSS), ISAP ≥48 months emerged as the optimal cutoff, stratifying 174 low-risk (ISAP <48 months) and 31 high-risk patients. ISAP ≥48 months independently predicted progression-free survival (HR 14.92, 95% CI 3.68-60.38; P < 0.001) and overall survival (HR 20.90, 95% CI 2.22-196.73; P = 0.008). Pathological risk factors showed no prognostic significance. Among low-risk patients managed without chemotherapy, no progression or mortality events occurred (0/85). Four (8.0%) FSS patients required salvage hysterectomy; all achieved 100% survival and none required completion hysterectomy after childbearing. CONCLUSIONS: ISAP ≥48 months is a robust prognostic determinant in Stage I PSTT. Surgery alone achieved excellent outcomes in low-risk patients; prospective trials should confirm whether chemotherapy can be safely omitted. FSS is viable for strictly selected low-risk candidates, with salvage hysterectomy providing effective control and subsequent term pregnancies documented.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}