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BJOG. 2013 Jul;120(8):1012-5. doi: 10.1111/1471-0528.12196. Epub 2013 Mar 21.

Uterine artery pulsatility index improves prediction of methotrexate resistance in women with gestational trophoblastic neoplasia with FIGO score 5-6.

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1
Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, London, UK.

Abstract

OBJECTIVE:

The Uterine Artery Pulsatility Index (UAPI) is an ultrasound measure of tumour vascularity. In this study, we hypothesised that a UAPI ≤ 1 (high vascularity) would identify women with gestational trophoblastic neoplasia (GTN) at increased risk of resistance to first-line single-agent methotrexate (MTX-R).

DESIGN:

Single-centre cohort study.

SETTING:

Charing Cross Hospital, a UK national centre for the treatment of trophoblastic disease.

POPULATION:

All women with a GTN FIGO score 5-6 treated with methotrexate (n = 92), between 1999 and 2011, at Charing Cross Hospital.

METHODS:

UAPI was measured before the start of chemotherapy, and women were monitored for the development of MTX-R.

MAIN OUTCOME MEASURES:

Frequency of MTX-R in women with UAPI ≤ 1 compared with UAPI >1.

RESULTS:

UAPI was measured before chemotherapy in 73 of 92 women with GTN FIGO score 5-6. UAPI ≤ 1 predicted MTX-R independent of the FIGO score (hazard ratio 2.9, P = 0.04), with an absolute risk of MTX-R in women with a UAPI ≤ 1 of 67% (95% CI 53-79%) compared with 42% (95% CI 24-61%) with a UAPI >1 (P = 0.036).

CONCLUSION:

Our results suggest UAPI is an independent predictor of MTX-R in women with FIGO 5-6 GTN.

PMID:
23759086
DOI:
10.1111/1471-0528.12196
[Indexed for MEDLINE]
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