A Network Meta-analysis Of The Efficacy Of Single-agent Chemotherapy For Low-risk Gestational Trophoblastic Neoplasia

Objective:To evaluate the efficacy and safety of different single-agent chemotherapy for low-risk gestational trophoblastic neoplasia systematically.Methods:1、Search strategy :Using computer retrieval as the main retrieval method,systematically and comprehensively search CNKI,Wanfang database,VIP database,Pubmed,Web of Science,Embase,Cochrane Library,EBSCO,Scopus and relevant references.2、Inclusion and exclusion criteria:Collect all the RCTs or CCTs of first-line single-agent Act-D-based OR MTX-based in LR-GTN.Restricted language is Chinese and English.Restricted time is from January,2000 to October,2021.3、Data collection and analysis :Relevant data extraction and quality assessment was completed by author independently.Using Stata 16.0 network meta-analysis software.4、The outcome assessment:⑴Efficacy evaluation :The complete remission rate,drug resistance rate.⑵Safety indicators : The incidence of adverse reaction of chemotherapy.Results:1、9 RCT and 4 NRCT were included in the review.There were 1165 patients and 5 kinds of chemotherapy in all 13 articles.2、Results analysis of network meta-analysis:⑴ The conclusion of complete response rate from direct comparison was as following: bi-ACT VS 5d-ACT（OR=0.06,95%CI（0.00,0.90））,w-MTX VS5d-ACT（OR=0.07,95%CI=（0.01,0.45））,MTX-FA VS bi-ACT（OR=0.04,95%CI=（0.00,0.49））,w-MTX VS bi-ACT（OR=0.21,95%CI=（0.09,0.52））,MTX-FA VS 5d-MTX（OR=0.09,95%CI=（0.01,0.73））.The SUCRA value（90.5%）of bi-ACT was the highest,5d-ACT（69.3%）and 5d-MTX（57.1%）took second place,while w-MTX（29.6%）and MTX-FA（3.4%）were the lowest.The complete response rate of bi-ACT was lower than 5d-ACT,but the result of ranking showed bi-ACT had the highest possibility of being the best treatment.Act-D was more effectively than MTX in the treatment of LR-GTN.⑵ The conclusion of drug resistance rate from direct comparison was as following: bi-ACT VS 5d-ACT（OR=62.90,95%CI（4.74,835.18））,w-MTX VS5d-ACT（OR=10.54,95%CI=（1.92,57.86））,MTX-FA VS bi-ACT（OR=15.45,95%CI=（1.49,159.77））,w-MTX VS bi-ACT（OR=4.52,95%CI=（1.99,,10.30））,MTX-FA VS 5d-MTX（OR=8.52,95%CI=（1.14,63.79））.The drug resistance rate of bi-ACT was higher than 5d-ACT,but the result of ranking showed bi-ACT had the highest possibility of being the best treatment.⑶5d-MTX VS bi-ACT（OR=16.75,95%CI=（1.07,262.00））,indicating the incidence of mucositis was higher in 5d-MTX than that in bi-ACT .bi-ACT VS5d-ACT（OR=0.10,95%CI=（0.01,0.84））,5d-MTX VS 5d-ACT（OR=0.10,95%CI=（0.02,0.65））,MTX-FA VS 5d-ACT（OR=0.02,95%CI=（0.00,0.28））,w-MTX VS 5d-ACT（OR=0.07,95%CI=（0.01,0.73））,indicating the incidence of alopecia was lower in bi-ACT、5d-MTX、MTX-FA、w-MTX than that in 5d-ACT.5d-MTX 与 5d-ACT（OR=4.32,95%CI=（1.92,9.74））,indicating the incidence of liver toxicity was higher in 5d-MTX than that in 5d-ACT.There were no statistical differences in other side effects.Conclusions:1、bi-ACT had the highest probability of being the best chemotherapy regimen for complete remission and drug resistance.2、The incidence of mucositis was higher in 5d-MTX than that in bi-ACT.The incidence of alopecia was highest in 5d-ACT.The incidence of liver toxicity was higher in 5d-MTX than that in 5d-ACT.There were no statistical differences in other side effects.3、More multicenter randomized controlled trials were required to strengthen the conclusion.