title: Identification of chemotherapeutic refractory cases based on human chorionic gonadotropin values among patients with low-risk persistent trophoblastic disease treated with 8-day methotrexate-folinic acid.
abstract: OBJECTIVE
  The aim of the present study was to establish the accurate cutoff points of post-treatment serum beta-hCG values in identifying chemotherapeutic refractory cases among patients with low-risk persistent trophoblastic disease (PTD) treated with 8-day methotrexate-folinic acid as the primary therapy.
  
  
  METHODS
  The values of serum beta-hCG measured before initiating treatment and weekly thereafter in 26 patients with low-risk PTD undergoing 8-day methotrexate-folinic acid treatment were analyzed. Thereafter, we determined the weekly cutoff points to identify the patient refractory for treatment by means of receiver-operating characteristic (ROC) plots analysis.
  
  
  RESULTS
  The values of cutoff points in the pretreatment, the post-treatment 1st, 2nd, 3rd, and 4th week were 18.6, 15.0, 5.4, 3.4, and 2.0 ng/ml, respectively, and the value of accuracy during these weeks was appropriate (> 80%). When using the cutoff points of one and two weeks after initiating treatment, the accuracy in identifying chemotherapeutic refractory patients was 87.5% and 88.0%, respectively, with the highest values exceeding 85%. The sensitivity and specificity at one week were 92.9 and 80.0%, respectively. Similarly, the sensitivity and specificity at two weeks were 93.3 and 80.0%, respectively.
  
  
  CONCLUSIONS
  These results suggest that the cutoff points of one and two weeks after initiating treatment are useful in identifying chemotherapeutic refractory patients among low-risk PTD patients, receiving 8-day methotrexate-folinic acid treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Shigematsu
authors.forename: T
authors.initials: T
authors.lastname: Hirakawa
authors.forename: H
authors.initials: H
authors.lastname: Yahata
authors.forename: T
authors.initials: T
authors.lastname: Sonoda
authors.forename: N
authors.initials: N
authors.lastname: Kinukawa
authors.forename: H
authors.initials: H
authors.lastname: Nakano
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage*; D008175:Lung Neoplasms / Q000097:blood / Q000188:drug therapy*; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D012016:Reference Values; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014328:Trophoblastic Neoplasms / Q000097:blood / Q000188:drug therapy*; D014594:Uterine Neoplasms / Q000097:blood / Q000188:drug therapy*
chemical_list: D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D002955:Leucovorin; D008727:Methotrexate