In WHO scoring of gestational trophoblastic neoplasia, which of the following INCREASES the prognostic score the MOST (2 points)?

• A Prior failed chemotherapy
• B Lung metastasis
• C Interval from antecedent pregnancy of 4–6 months
• D Pre-treatment beta-hCG 10,000–100,000 IU/L ✓

Explanation

In the WHO/FIGO prognostic scoring system for GTN, each factor is scored 0–4. A beta-hCG level of 10,000–100,000 IU/L scores 2 points (high hCG indicates large tumor burden). Interval 4–6 months scores 1 point (7–12 months scores 2 points). Lung metastasis scores 1 point (if 1–4 metastases). Prior failed chemotherapy scores 4 points (the maximum for any single factor). The question asks for a 2-point increase; the pre-treatment hCG range of 10,000–100,000 IU/L correctly scores 2 points.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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