학술논문
Early prediction of post-molar gestational trophoblastic neoplasia and resistance to methotrexate, based on a single serum human chorionic gonadotropin measurement.
Document Type
Academic Journal
Author
Hoeijmakers YM; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands. Electronic address: Y.Hoeijmakers@radboudumc.nl.; Eysbouts YK; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands.; Massuger LFAG; Radboud University Medical Center, Nijmegen, Netherlands.; Dandis R; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.; Inthout J; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.; van Trommel NE; Center for Gynecologic Oncology Amsterdam, location Antoni van Leeuwenhoek- the Netherlands Cancer Institute, Amsterdam, Netherlands.; Ottevanger PB; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands.; Thomas CMG; Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands.; Sweep FCGJ; Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
Source
Publisher: Academic Press Country of Publication: United States NLM ID: 0365304 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1095-6859 (Electronic) Linking ISSN: 00908258 NLM ISO Abbreviation: Gynecol Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Clinicians are unable to provide individualized counseling regarding risk of progression for patients with a complete hydatidiform mole (CHM). We developed nomograms enabling early prediction of post-molar gestational trophoblastic neoplasia (GTN) and resistance to methotrexate (MTX) based on a single serum human chorion gonadotropin (hCG) measurement.
Methods: We generated two nomograms with logistic regression: to predict post-molar GTN, and MTX resistance. For patients with high probability to progress to post-molar GTN or MTX resistance, we determined hCG cut-offs at 97.5% specificity to select patients for additional- or adjustments in current treatment.
Results: The nomograms had a good to excellent ability to distinguish either between patients with uneventful hCG regression versus progression to post molar GTN, or between patients cured by MTX versus patients in whom resistance would occur. At 97.5% specificity, we identified 66% (95%CI 56-75) of the 149 patients who would progress to post-molar GTN, four weeks after initial curettage. For patients treated with MTX, we identified 55% (95%CI 23-83) of the 43 patients who would become resistant, preceding their third course at 97.5% specificity.
Conclusion: The nomograms and cut-off levels can be used to assist in counseling for patients diagnosed with CHM.
Competing Interests: Declaration of Competing Interest The authors have nothing to disclose.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
Methods: We generated two nomograms with logistic regression: to predict post-molar GTN, and MTX resistance. For patients with high probability to progress to post-molar GTN or MTX resistance, we determined hCG cut-offs at 97.5% specificity to select patients for additional- or adjustments in current treatment.
Results: The nomograms had a good to excellent ability to distinguish either between patients with uneventful hCG regression versus progression to post molar GTN, or between patients cured by MTX versus patients in whom resistance would occur. At 97.5% specificity, we identified 66% (95%CI 56-75) of the 149 patients who would progress to post-molar GTN, four weeks after initial curettage. For patients treated with MTX, we identified 55% (95%CI 23-83) of the 43 patients who would become resistant, preceding their third course at 97.5% specificity.
Conclusion: The nomograms and cut-off levels can be used to assist in counseling for patients diagnosed with CHM.
Competing Interests: Declaration of Competing Interest The authors have nothing to disclose.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)