title: 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 (χ(2) P<0.0001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK. roshan.agarwal@imperial.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Agarwal
authors.forename: V
authors.initials: V
authors.lastname: Harding
authors.forename: D
authors.initials: D
authors.lastname: Short
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.forename: N J
authors.initials: NJ
authors.lastname: Sebire
authors.forename: R
authors.initials: R
authors.lastname: Harvey
authors.forename: D
authors.initials: D
authors.lastname: Patel
authors.forename: P M
authors.initials: PM
authors.lastname: Savage
authors.forename: A K P
authors.initials: AK
authors.lastname: Lim
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000494:pharmacology* / Q000627:therapeutic use; D001783:Blood Flow Velocity; D019008:Drug Resistance, Neoplasm; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000098:blood supply* / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D008727:Methotrexate / Q000494:pharmacology* / Q000627:therapeutic use; D015999:Multivariate Analysis; D011247:Pregnancy; D011673:Pulsatile Flow; D012307:Risk Factors; D018709:Statistics, Nonparametric; D055988:Uterine Artery / Q000503:physiopathology*
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate