Uterine artery pulsatility index improves prediction of methotrexate resistance in women with gestational trophoblastic neoplasia with FIGO score 5–6. Issue 8 (21st March 2013)

• Record Type: Journal Article
• Authors: Sita‐Lumsden, A; Medani, H; Fisher, R; Harvey, R; Short, D; Sebire, N; Savage, P; Lim, A; Seckl, MJ; Agarwal, R
• Is Part Of: BJOG. Volume 120:Issue 8(2013:Aug.)
• Page Start: 1012
• Page End: 1015
• Publication Date: 2013-03-21
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12196
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12196-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12196-sec-0001" sec-type="section"> <title>Objective</title> <p>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).</p> </sec> <sec id="bjo12196-sec-0002" sec-type="section"> <title>Design</title> <p>Single‐centre cohort study.</p> </sec> <sec id="bjo12196-sec-0003" sec-type="section"> <title>Setting</title> <p>Charing Cross Hospital, a UK national centre for the treatment of trophoblastic disease.</p> </sec> <sec id="bjo12196-sec-0004" sec-type="section"> <title>Population</title> <p>All women with a GTN FIGO score 5–6 treated with methotrexate (<italic>n</italic> = 92), between 1999 and 2011, at Charing Cross Hospital.</p> </sec> <sec id="bjo12196-sec-0005" sec-type="section"> <title>Methods</title> <p>UAPI was measured before the start of chemotherapy, and women were monitored for the development of MTX‐R.</p> </sec> <sec id="bjo12196-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Frequency of MTX‐R in women with UAPI ≤1 compared with UAPI >1.</p> </sec> <sec id="bjo12196-sec-0007" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> = 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 (<italic>P</italic> = 0.036).</p> </sec> <sec id="bjo12196-sec-0008" sec-type="section"> <title>Conclusion</title> <p>Our results suggest UAPI is an independent predictor of MTX‐R in women with FIGO 5–6 GTN.</p> </sec> </abstract>