Uterine artery pulsatility index: a predictor of methotrexate resistance in gestational trophoblastic neoplasia

被引：44
作者：
Agarwal, R. [1 ]
Harding, V. [1 ]
Short, D. [1 ]
Fisher, R. A. [1 ]
Sebire, N. J. [1 ]
Harvey, R. [1 ]
Patel, D. [1 ]
Savage, P. M. [1 ]
Lim, A. K. P. [1 ]
Seckl, M. J. [1 ]
机构：
[1] Imperial Coll Healthcare NHS Trust, Charing Cross Hosp, Charing Cross Gestat Trophoblast Dis Ctr, Dept Med Oncol, London W6 8RF, England
来源：
BRITISH JOURNAL OF CANCER | 2012年 / 106卷 / 06期
关键词：
low-risk GTN; UAPI; drug resistance; angiogenesis; HUMAN CHORIONIC-GONADOTROPIN; TUMOR ANGIOGENESIS; HYDATIDIFORM MOLE; RISK; DISEASE; MANAGEMENT; HCG;
D O I：
10.1038/bjc.2012.65
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
BACKGROUND: Neo-angiogenesis is a hallmark of cancer. The aim of this study was to test the hypothesis, in a prospective patient cohort, that in low-risk gestational trophoblastic neoplasia (LR-GTN) the uterine artery pulsatility index (UAPI), a measure of tumour vascularity, can predict resistance to methotrexate chemotherapy (MTX-R). METHODS: 286 LR-GTN patients (Charing Cross Hospital (CXH) score 0-8, or FIGO score 0-6) were treated with methotrexate between January 2008 and June 2011 at CXH. During staging investigations, patients underwent a Doppler ultrasound to assess the UAPI. RESULTS: 239 patients were assessable for both UAPI and MTX-R. The median UAPI was lower (higher vascularity) in MTX-R compared with MTX-sensitive patients (0.8 vs 1.4, P<0.0001). In multivariate logistic regression, UAPI <= 1 predicted MTX-R, independent of both CXH and FIGO scores. The risk of MTX-R in patients with a FIGO score of 6 and UAPI <= 1 was 100% vs 20% in patients with UAPI>1 (chi(2) P<0.0001). CONCLUSION: UAPI represents an independently validated clinically useful predictor of MTX-R in LR-GTN. Further, consideration of whether to incorporate UAPI into the FIGO scoring system is now warranted so that patients with a score of 6 and a UAPI <= 1 might be upstaged and offered combination chemotherapy rather than MTX. British Journal of Cancer (2012) 106, 1089-1094. doi:10.1038/bjc.2012.65 www.bjcancer.com Published online 28 February 2012 (C) 2012 Cancer Research UK
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页码：1089 / 1094
页数：6
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