Strategies for managing EMA/CO resistant in gestational trophoblastic neoplasia a systematic review and meta analysis
Why this work is in the frame
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Bibliographic record
Abstract
OBJECTIVE: This systematic review and meta-analysis evaluate the efficacy and safety of salvage regimens in managing EMA/CO-resistant GTN, providing evidence to inform optimal treatment strategies. METHODS: A literature search was conducted in PubMed, ScienceDirect, Cochrane Library, Google Scholar, and Wiley Online Library until December 27, 2024. Studies on EMA/CO chemoresistance in gestational trophoblastic neoplasia (GTN) were included, and alternative regimens and surgical interventions were also considered. Exclusion applied to non-human studies and those unrelated to EMA/CO chemoresistance. Data extraction and quality assessment followed PRISMA, Cochrane ROB-2, and the Newcastle-Ottawa Scale. A meta-analysis was performed using a random-effects model, with heterogeneity (I²) and publication bias assessed. The study was registered with PROSPERO (CRD42024574582). RESULTS: Eight studies met the inclusion criteria, encompassing patients predominantly with advanced-stage (FIGO III-IV) and high-risk GTN. EMA/EP and EP/EMA were the most frequently evaluated salvage regimens, with a pooled complete remission rate of 78.7% (95% CI: 67.4–88.1%) across 84 patients. No significant heterogeneity (I² = 27.05%) or publication bias was detected. Alternative regimens, including BEP, FAEV, and TP/TE, demonstrated favourable remission rates in small cohorts but lacked generalizability. Neutropenia (68%), thrombocytopenia (41%), and anaemia (30%) were the most commonly reported toxicities with EP/EMA. Safety data for other regimens were limited. CONCLUSION: EMA/EP and EP/EMA remain the most effective and well-studied salvage regimens for EMA/CO-resistant GTN, demonstrating high remission rates with manageable toxicity. While alternative regimens such as BEP, FAEV, and TP/TE show encouraging results, their limited evidence base precludes definitive comparison. Further prospective studies are needed to establish optimal salvage strategies and refine toxicity management.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.009 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it