Banach Paulina, Zaborowski Mikolaj Piotr, Izycka Natalia, Romala Anna, Nowak-Markwitz Ewa
Department of Gynecology, Obstetrics and Gynecologic Oncology, Division of Gynecologic Oncology, Poznan University of Medical Sciences, Poznan, Poland.
Division of Perinatology and Women's Diseases, Poznan University of Medical Sciences, Poznan, Poland.
Ginekol Pol. 2019;90(3):141-147. doi: 10.5603/GP.2019.0025.
The early identification of patients who are being treated for low-risk gestational trophoblastic neoplasia (LRGTN) with single-agent chemotherapy, who are at high risk of developing chemoresistance, is of crucial importance. The aim of our research was to evaluate the pretreatment beta subunit of human chorionic gonadotropin (βhCG) concentration and its decrease after the administration of the first course of methotrexate (MTX) in predicting later chemo-resistance to single-agent chemotherapy.
A total of 46 patients diagnosed with LRGTN treated with a 5-day methotrexate (MTX) regimen were retrospectively studied. 24 of the patients were successfully cured with only MTX therapy (MTX group). The disease was considered resistant in the remaining 22 patients who, after MTX therapy, required further chemotherapy with an EMA/CO regimen (EMA/CO group). To compare changes in the βhCG concentrations between the two courses of treatment (and the two groups), we calculated the percentage of decline. We determined the specificity and sensitivity of the initial βhCG level and its percentage decline, as a potential predictor of the need for a future EMA/CO regimen. For diagnostic purposes, βhCG levels were measured before the first and second administrations of MTX with a commercial ELISA kit.
In the EMA/CO group, we found the initial βhCG level before the first MTX dose was higher (median = 6275 mIU/mL, range: 21.53-192.610.0 mIU/mL) than in the MTX group (median = 532 mIU/mL, range: 56.5 mIU/mL-360.397.0 mIU/mL) (p = 0.034, Mann-Whitney test). The percentage decreases in the βhCG values relative to the initial concentrations were higher in the MTX group (median decrease = 82.7%, range: from 13.3% to 99.9%) than in the EMA/CO group (median de- crease = 71.1%, range: from an increase of 56.1% to a decrease of 97.1%) (p = 0.0079, Mann-Whitney test). An analysis of the ROC curves implied optimal cutoff values for the initial βHCG (6054 IU, sensitivity = 55%, specificity = 86%) and the percentage change in βhCG levels (decrease by 76.5%, sensitivity = 72%, specificity = 71%).
Women with initially higher βhCG levels have a greater risk of developing MTX chemo resistance. It would be advantageous to consider administering an EMA/CO regimen in women with LRGTN when their initial βhCG levels are greater than 6000.
对于正在接受单药化疗治疗低危妊娠滋养细胞肿瘤（LRGTN）且发生化疗耐药风险高的患者，尽早识别至关重要。我们研究的目的是评估人绒毛膜促性腺激素（βhCG）的预处理浓度及其在给予首个疗程甲氨蝶呤（MTX）后下降情况，以预测后续对单药化疗的耐药性。
对46例诊断为LRGTN并接受5天甲氨蝶呤（MTX）方案治疗的患者进行回顾性研究。24例患者仅接受MTX治疗即成功治愈（MTX组）。其余22例患者在MTX治疗后疾病被认为耐药，需进一步采用EMA/CO方案化疗（EMA/CO组）。为比较两个疗程治疗（及两组）间βhCG浓度变化，我们计算了下降百分比。我们确定初始βhCG水平及其下降百分比作为未来是否需要EMA/CO方案的潜在预测指标的特异性和敏感性。为诊断目的，使用商用ELISA试剂盒在首次和第二次给予MTX前测量βhCG水平。
在EMA/CO组中，我们发现首次MTX剂量前的初始βhCG水平高于MTX组（中位数 = 6275 mIU/mL，范围：21.53 - 192610.0 mIU/mL）（中位数 = 532 mIU/mL，范围：56.5 mIU/mL - 360397.0 mIU/mL）（p = 0.034，Mann-Whitney检验）。相对于初始浓度，MTX组βhCG值的下降百分比更高（中位数下降 = 82.7%，范围：13.3%至99.9%），高于EMA/CO组（中位数下降 = 71.1%，范围：从增加56.1%至下降97.1%）（p = 0.0079，Mann-Whitney检验）。ROC曲线分析表明初始βHCG的最佳截断值为6054 IU（敏感性 = 55%，特异性 = 86%）以及βhCG水平变化百分比（下降76.5%，敏感性 = 72%，特异性 = 71%）。
初始βhCG水平较高的女性发生MTX化疗耐药的风险更大。对于初始βhCG水平大于6000的LRGTN女性，考虑给予EMA/CO方案将是有益的。
