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Resistance to single‐agent chemotherapy and its risk factors in low‐risk gestational trophoblastic neoplasms
Author(s) -
Mousavi Azam Sadat,
Zamani Ashraf,
Khorasanizadeh Faezeh,
Gilani Mitra Modarres,
Zendehdel Kazem
Publication year - 2015
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12613
Subject(s) - medicine , odds ratio , chemotherapy , confidence interval , trophoblastic neoplasm , gestational trophoblastic disease , gestational age , pregnancy , gastroenterology , drug resistance , gestation , oncology , surgery , biology , microbiology and biotechnology , genetics
Aim Gestational trophoblastic neoplasm ( GTN ) is a rare disease which is classified into high‐ and low‐risk groups. While the high‐risk patients require combination therapy, the low‐risk groups respond to single‐agent chemotherapy. We studied resistance to single‐agent chemotherapy and its risk factors among the low‐risk GTN patients in I ran. Methods We followed 168 low‐risk GTN patients who were treated between 2001 and 2011 in V aliasr H ospital, T ehran, I ran. We used a case–control design and studied odds ratios ( OR ) and corresponding 95% confidence intervals ( CI ) to evaluate association between drug resistance and different personal and clinical variables. Results Resistance to sequential single‐agent chemotherapy was 19%, although all patients had a complete remission after a combination of chemotherapy and/or surgery. Patients who had I nternational F ederation of G ynecology and O bstetrics scores of 5–6 – considered as, the intermediate risk group – had a 14‐fold higher resistance compared with the low score patients ( OR = 14.28, 95% CI = 5.54–36.81). We found higher risk of resistance among patients with metastasis ( OR = 8.42, 95% CI = 2.44–29.07), large tumor size (>3 cm) ( OR = 7.73, 95% CI = 1.93–30.91), high β‐h CG (>100 000 IU /L) ( OR = 5.86, 95% CI = 1.07–32.02) and/or a diagnosis more than 4 months after pregnancy ( OR = 3.30, 95% CI = 1.08–10.02), compared with their reference group. We found no priority for the different chemotherapy regimens. Conclusion Intermediate risk GTN patients had a higher risk of resistance to chemotherapy compared with low‐risk patients. Clinical trials and cost‐effectiveness studies are needed to suggest a better treatment program for the intermediate risk group.