Department of Gynecologic Oncology, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Municipal Key Clinical Specialty of Gynecologic Oncology, Shanghai, China.
J Obstet Gynaecol Res. 2022 Dec;48(12):3128-3136. doi: 10.1111/jog.15413. Epub 2022 Sep 2.
The aim of this study is to investigate the role of human chorionic gonadotropin (hCG) daily variations and levels prior to methotrexate treatment as predictors for treatment outcome.
This retrospective study included patients who had a sonographically confirmed ectopic pregnancy at the International Peace Maternity and Child Health Hospital between November 2015 and June 2020. The associations of hCG levels and daily variations with the treatment success were evaluated by multivariable logistic regression and receiver operator characteristic (ROC) curve. Establish a nomogram that predicts how methotrexate (MTX) therapy will turn out. The performance of the model was assessed utilizing concordance index, receiver operating characteristic curves, and calibration plots.
The median serum hCG levels before treatment and hCG daily variation in the failure group were higher than those in the success group (487.8 vs. 270.7 IU/L, -1.86% vs. 7.29%, both p < 0.01). According to the ROC curve analysis, the cutoff values of serum hCG level before treatment and daily variations were 617.35 IU/L and 1.76%/day. By multivariable logistic regression analysis, serum hCG levels before treatment (odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1.000 ~ 1.001) and hCG daily variations were independently associated with the treatment success (OR: 1.033, 95% CI: 1.015 ~ 1.052). The nomogram was effective at predicting the outcome of MTX treatment with a receiver operating characteristic area under the curve of 0.717 (p < 0.001). The nomogram's calibration curve was almost parallel to the ideal diagonal line.
We successfully created a nomogram based on serum hCG levels before treatment and hCG daily changes to anticipate the result of MTX therapy, which could assist medical professionals in selecting therapeutic schedule for patients with tubal pregnancies.
本研究旨在探讨人绒毛膜促性腺激素（hCG）在甲氨蝶呤（MTX）治疗前的日变化和水平作为预测治疗结局的指标。
本回顾性研究纳入了 2015 年 11 月至 2020 年 6 月期间在国际和平妇幼保健院经超声证实的异位妊娠患者。采用多变量逻辑回归和受试者工作特征（ROC）曲线评估 hCG 水平和日变化与治疗成功的相关性。建立一个预测 MTX 治疗结果的列线图。通过一致性指数、ROC 曲线和校准图评估模型的性能。
治疗失败组治疗前血清 hCG 水平中位数和 hCG 日变化率均高于治疗成功组（487.8 vs. 270.7IU/L，-1.86% vs. 7.29%，均 p<0.01）。根据 ROC 曲线分析，治疗前血清 hCG 水平和 hCG 日变化率的截断值分别为 617.35IU/L 和 1.76%/天。多变量逻辑回归分析显示，治疗前血清 hCG 水平（比值比[OR]：1.001，95%置信区间[CI]：1.0001.001）和 hCG 日变化与治疗成功独立相关（OR：1.033，95%CI：1.0151.052）。列线图在预测 MTX 治疗结局方面具有良好的效果，ROC 曲线下面积为 0.717（p<0.001）。列线图的校准曲线几乎与理想的对角线平行。
我们成功地基于治疗前血清 hCG 水平和 hCG 日变化建立了一个预测 MTX 治疗结果的列线图，这有助于临床医生为输卵管妊娠患者选择治疗方案。
