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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Gynecological Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1368543
This article is part of the Research Topic Cancer Immunology and Pregnancy View all 3 articles

Predicting Monotherapy Resistance Risk in Patients with Low-Risk Gestational Trophoblastic Neoplasia: Integration of the Systemic Immune-Inflammation Index and the Prognostic Nutritional Index

Provisionally accepted
Tianfu Lin Tianfu Lin 1Caijin Wu Caijin Wu 1Meilian Peng Meilian Peng 2*Lihua Chen Lihua Chen 3,4,5*Wenyu Lin Wenyu Lin 1*Meijin Zheng Meijin Zheng 6*Qibin Wu Qibin Wu 6*Pengming Sun Pengming Sun 6,7*
  • 1 Fujian Medical University, Fuzhou, China
  • 2 Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, China
  • 3 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (CAMS), Beijing, Beijing Municipality, China
  • 4 Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing Municipality, China
  • 5 National Clinical Research Center for Obstetrics and Gynecology, Peking Union Medical College Hospital (CAMS), Beijing, China
  • 6 Fujian Maternity and Child Health Hospital, Fuzhou, Fujian Province, China
  • 7 Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian Province, China

The final, formatted version of the article will be published soon.

    Purpose: Currently, there are no reliable indicators for the early identification of patients with low-risk gestational trophoblastic neoplasia (GTN) who develop resistance to monotherapy. This study aimed to evaluate the effectiveness of combining the Systemic Immune-Inflammation Index (SII) and Prognostic Nutritional Index (PNI) in detecting early resistance to monotherapy in patients with low-risk GTN.: This retrospective study included 91 patients with low-risk GTN who received initial monotherapy at Fujian Maternal and Child Health Hospital between 2013 and 2021. The SII and PNI before chemotherapy were calculated from prechemotherapy peripheral blood samples, with cut-off values determined by receiver operating characteristic (ROC) curves. The SII-PNI score ranged from 0 to 2 points and was categorized as follows: a score of 2 points indicated a high SII (≥467.02) and a low PNI (≤51.35); a score of 1 point indicated either a high SII or a low PNI; and a score of 0 points indicated neither a high SII nor a low PNI.Results: Ninety-one patients with low-risk GTN underwent monotherapy, 19 of whom developed resistance, whereas the remaining 72 did not. The SII was significantly greater in chemotherapy-resistant patients than in nonresistant patients (P=0.04), whereas the PNI was markedly lower in chemotherapy-resistant patients (P=0.002). Univariate analysis revealed that cut-off values of 467.02 for the SII (P=0.04) and 51.35 for the PNI (P=0.024) were associated with chemotherapy resistance in patients with low-risk GTN. As the SII-PNI score increased, the proportion of chemotherapy-resistant patients increased (P<0.001), and the time for human chorionic gonadotropin (hCG) normalization correspondingly increased (P<0.001). Multivariate logistic regression analysis indicated that a high SII-PNI score is an independent risk factor for chemotherapy resistance in patients with low-risk GTN (P=0.001).A high SII and low PNI are linked to chemotherapy resistance in patients with low-risk GTN. The pretreatment SII-PNI score is a key indicator for predicting the sensitivity of patients with low-risk GTN to single-agent chemotherapy, aiding in the early identification of individuals at high risk of resistance.

    Keywords: Gestational trophoblastic neoplasia, Systemic immune-inflammatory index, Prognostic nutritional index, low-risk, chemotherapy resistance

    Received: 10 Jan 2024; Accepted: 10 Sep 2024.

    Copyright: © 2024 Lin, Wu, Peng, Chen, Lin, Zheng, Wu and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Meilian Peng, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian Province, China
    Lihua Chen, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital (CAMS), Beijing, 100730, Beijing Municipality, China
    Wenyu Lin, Fujian Medical University, Fuzhou, China
    Meijin Zheng, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, Fujian Province, China
    Qibin Wu, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, Fujian Province, China
    Pengming Sun, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, Fujian Province, China

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