title: Uterine artery pulsatility index improves prediction of methotrexate resistance in women with gestational trophoblastic neoplasia with FIGO score 5-6.
abstract: OBJECTIVE
  The Uterine Artery Pulsatility Index (UAPI) is an ultrasound measure of tumour vascularity. In this study, we hypothesised that a UAPI ≤ 1 (high vascularity) would identify women with gestational trophoblastic neoplasia (GTN) at increased risk of resistance to first-line single-agent methotrexate (MTX-R).
  
  
  METHODS
  Single-centre cohort study.
  
  
  METHODS
  Charing Cross Hospital, a UK national centre for the treatment of trophoblastic disease.
  
  
  METHODS
  All women with a GTN FIGO score 5-6 treated with methotrexate (n = 92), between 1999 and 2011, at Charing Cross Hospital.
  
  
  METHODS
  UAPI was measured before the start of chemotherapy, and women were monitored for the development of MTX-R.
  
  
  METHODS
  Frequency of MTX-R in women with UAPI ≤ 1 compared with UAPI >1.
  
  
  RESULTS
  UAPI was measured before chemotherapy in 73 of 92 women with GTN FIGO score 5-6. UAPI ≤ 1 predicted MTX-R independent of the FIGO score (hazard ratio 2.9, P = 0.04), with an absolute risk of MTX-R in women with a UAPI ≤ 1 of 67% (95% CI 53-79%) compared with 42% (95% CI 24-61%) with a UAPI >1 (P = 0.036).
  
  
  CONCLUSIONS
  Our results suggest UAPI is an independent predictor of MTX-R in women with FIGO 5-6 GTN.
authors.affiliation: Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sita-Lumsden
authors.forename: H
authors.initials: H
authors.lastname: Medani
authors.forename: R
authors.initials: R
authors.lastname: Fisher
authors.forename: R
authors.initials: R
authors.lastname: Harvey
authors.forename: D
authors.initials: D
authors.lastname: Short
authors.forename: N
authors.initials: N
authors.lastname: Sebire
authors.forename: P
authors.initials: P
authors.lastname: Savage
authors.forename: A
authors.initials: A
authors.lastname: Lim
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
authors.forename: R
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D015331:Cohort Studies; D019008:Drug Resistance, Neoplasm / Q000502:physiology*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D018570:Risk Assessment; D006113:United Kingdom; D055988:Uterine Artery / Q000503:physiopathology*; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D008727:Methotrexate