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

Abstract

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 (χ2 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.

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

“…The uterine artery pulsatility index (UAPI) is a Doppler ultrasound measure of tumour vascularity, and we have previously shown that a UAPI ≤1 (high vascularity) is an independent predictor of MTX‐R in women with low‐risk disease. The predicted risk of MTX‐R in women with a UAPI ≤1 and a FIGO score of 5–6 was >75%, suggesting that these women might benefit from initial EMA/CO therapy . However, a significant limitation of our previous two studies was that women with FIGO 5–6 GTN constituted only a small proportion (10%) of the overall patient cohorts (16/164 and 24/239 women) .…”

Diagnosis, classification and treatment of gestational trophoblastic neoplasia

“…When there is no response to sequential single-agent therapy, multiagent ChT should be initiated, and the EMA-CO regimen is the most commonly used multiagent ChT 4 . Recent studies suggest that a uterine artery pulsatility index equal to or lower than one predicts an increase in the risk of resistance to MTX/FA in women with low-risk GTN and may be useful in patient staging for first line therapy 44,45 . Prospective studies are underway evaluate this finding.…”

Comparison of 2 Human Chorionic Gonadotropin Immunoassays Commercially Available for Monitoring Patients With Gestational Trophoblastic Disease

“…In this case, uterine artery Doppler pulsatility index was less than 1, which is an independently validated predictor of methotrexate resistance in low-risk GTN. 24 Consistently, Architect showed a plateau, which is indicative of methotrexate resistance, whereas Immulite showed a decline in hCG.…”