Chemotherapy resistance and risk stratification in gestational trophoblastic neoplasia: A systematic review and network meta-analysis.
Ying-Ying Xue, Xin-Yue Yang, Fang-Yu Chen et al.
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In 30 seconds
This systematic review and network meta-analysis examined pretreatment predictors of chemotherapy resistance and compared resistance across regimens in gestational trophoblastic neoplasia (GTN). Across 53 studies involving 7585 patients, 1997 resistant cases were reported; the pooled chemoresistance rate was 23.8% (95% CI: 20.7%-27.1%; p < 0.001). Resistance was associated with several pretreatment features, including higher FIGO score, greater tumor burden, elevated β-hCG, and characteristics of the antecedent pregnancy. Exploratory regimen rankings placed etoposide-containing regimens, particularly FAEV, lower for predicted resistance, but the authors call for prospective validation.
Key findings
- The pooled chemoresistance rate was 23.8% (95% CI: 20.7%-27.1%; p < 0.001) across 53 studies and 7585 patients.
- Higher resistance was associated with high FIGO score, elevated pretreatment β-hCG, metastases, larger tumors, and longer intervals from antecedent pregnancy.
- Exploratory rankings suggested lower predicted resistance with etoposide and FAEV, while methotrexate and fluorouracil ranked higher.
Why it matters
Chemoresistance affects a substantial proportion of patients with GTN, and the review identifies pretreatment clinical and tumor features that may help distinguish higher-risk cases. This synthesis also highlights uncertainty in comparative regimen evidence: ranking results may inform research priorities, but they do not establish that one regimen is superior for an individual patient.
What to keep in mind
The regimen comparisons were exploratory, and the authors state that the findings require prospective validation before informing treatment selection.