Observational studyRevista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia2026
Impact of different EMA/CO treatment regimens in women with gestational trophoblastic neoplasia: brazilian multicenter retrospective cohort study.
Observational study in Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To compare the clinical outcome of women with gestational trophoblastic neoplasia (GTN) treated with the conventional EMA/CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) with those treated with the modified EM/CO regimen. Methods: Brazilian multicenter retrospective cohort study evaluated medical records of women diagnosed with GTN who were treated with the standard EMA/CO or with the modified regimen in which actinomycin-D was suppressed (EM/CO). The primary outcome was the occurrence of remission following chemotherapy treatment. Results: Remission rate with EMA/CO was 85.3%, with 14.7% of women showing chemoresistance, while with EM/CO, the remission rate was 72.7%, with 27.3% of women chemoresistance, without statistical difference between the groups. A total of 142 women were analyzed, of whom 109 were treated with EMA/CO and 33 received EM/CO. Women who used the EM/CO had higher prevalence of invasive mole (51.5% vs. 14.7%, p<0.0001), lower prevalence of choriocarcinoma (9.1% vs. 26.6%, p=0.035), and lower prevalence of metastases (33.3% vs. 61.5%, p=0.004) compared to women who received the EMA/CO. Women with risk score ≥ 7 had higher prevalence of recurrence (61.5% vs 10.0%, p=0.005) and chemoresistance using the EM/CO (53.8% vs 10.0%, p=0.013) compared to women with score ≤ 6. The pre-treatment serum hCG levels was a moderately significant predictor (AUC: 0.77, 95%CI 0.66-0.88, p<0.0001) for identifying chemoresistance. The number of EM/CO cycles was a strong significant predictor (AUC: 0.81, 95%CI 0.66-0.96, p<0.0001) for identifying toxicity to chemotherapy. Conclusion: EM/CO had higher prevalence of need for second-line treatment, and chemoresistance.
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