Abstract
Objective
The International Federation of Gynecology and Obstetrics (FIGO) 2000 scoring system classifies gestational trophoblastic neoplasia (GTN) patients into low- and high-risk groups, so that single- or multi-agent chemotherapy can be administered accordingly. However, a number of FIGO-defined low-risk patients still exhibit resistance to single-agent regimens, and the risk factors currently adopted in the FIGO scoring system possess inequable values for predicting single-agent chemoresistance. The purpose of this study is therefore to evaluate the efficacy of risk factors in predicting single-agent chemoresistance and explore the feasibility of simplifying the FIGO 2000 scoring system for GTN.
Methods
The clinical data of 578 GTN patients who received chemotherapy between January 2000 and December 2018 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were carried out to identify risk factors associated with single-agent chemoresistance in low-risk GTN patients. Then, simplified models were built and compared with the original FIGO 2000 scoring system.
Results
Among the eight FIGO risk factors, the univariate and multivariate analyses identified that pretreatment serum human chorionic gonadotropin (hCG) level and interval from antecedent pregnancy were consistently independent predictors for both first-line and subsequent single-agent chemoresistance. The simplified model with two independent factors showed a better performance in predicting single-agent chemoresistance than the model with the other four non-independent factors. However, the addition of other co-factors did improve the efficiency. Overall, simplified models can achieve favorable performance, but the original FIGO 2000 prognostic system still features the highest discrimination.
Conclusions
Pretreatment serum hCG level and interval from antecedent pregnancy were independent predictors for both first-line and subsequent single-agent chemoresistance, and they had greater weight than other non-independent factors in predicting single-agent chemoresistance. The simplified model composed of certain selected factors is a promising alternative to the original FIGO 2000 prognostic system, and it shows comparable performance.
摘要
目的
评估现行国际妇产科联盟(FIGO)2000预后评分系统中各因素的作用, 从中筛选出与单药化疗失败相关的独立危险因素, 并基于此简化现行的预后评分系统。
创新点
临床数据样本量大, 简化模型预测效能优秀, 具有一定的临床价值。
方法
回顾性收集浙大妇院过去19年(2000年1月至2018年12月)收治的共578例妊娠滋养细胞肿瘤患者的临床数据, 通过单因素和多因素Logistics回归分析筛选出与单药化疗失败相关的独立危险因素, 从而在现行的FIGO 2000预后评分系统的基础上建立更简化的预测模型。
结论
先前妊娠距化疗开始间隔时间和治疗前血清人绒毛膜促性腺激素(hCG)水平是妊娠滋养细胞肿瘤患者单药化疗失败的独立危险因素, 基于这两项独立危险因素建立的简化模型对于妊娠滋养细胞肿瘤患者单药化疗疗效的预测具有良好效能。
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Yang WENG and Yuanyuan LIU contributed to data interpretation, statistical analysis, and writing the manuscript. Yuanyuan LIU and Xiaodong WU contributed to data extraction and draft preparation. Chitapa BENJOED contributed to revising the manuscript. Yang WENG and Sangsang TANG contributed to statistical analysis. Xiao LI contributed to data interpretation and supervision. Xing XIE and Weiguo LU contributed to conception, reviewing and editing the final manuscript. All authors have read and approved the final manuscript, and therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Yang WENG, Yuanyuan LIU, Chitapa BENJOED, Xiaodong WU, Sangsang TANG, Xiao LI, Xing XIE, and Weiguo LU declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the Ethics Committee of Women’s Hospital, School of Medicine, Zhejiang University (approval number: IRB-20190003-R) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was waived due to its nature of retrospective analysis.
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Weng, Y., Liu, Y., Benjoed, C. et al. Evaluation and simplification of risk factors in FIGO 2000 scoring system for gestational trophoblastic neoplasia: a 19-year retrospective analysis. J. Zhejiang Univ. Sci. B 23, 218–229 (2022). https://doi.org/10.1631/jzus.B2100895
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DOI: https://doi.org/10.1631/jzus.B2100895