In gestational trophoblastic neoplasia (GTN), the 2000 FIGO scoring system guides chemotherapy selection. A patient with a score of 7 following a term pregnancy (with score contribution from site) has 'intermediate risk' GTN. According to the FIGO 2000 scoring system, which factor contributes the MOST points in a high-score (≥7) situation?
- A Antecedent pregnancy: term gestation (2 points)
- B Number of metastases: >8 metastases (4 points)
- C Metastatic site: liver or brain (4 points each) ✓
- D Prior chemotherapy: 2+ drugs (4 points)
Explanation
In the FIGO 2000 prognostic scoring system for GTN, brain and liver metastases each score 4 points—the maximum for any single factor. Other 4-point factors include prior failed multi-agent chemotherapy. Scoring is: antecedent pregnancy (hydatidiform mole=0, abortion=1, term=2), interval from index pregnancy (≤4m=0, 4–7m=1, 7–13m=2, >13m=4), pretreatment hCG, largest tumor, site of metastases (lung=0, spleen/kidney=1, GI=2, liver/brain=4), number of metastases, prior chemotherapy. Total score ≤6 = low-risk (single-agent methotrexate/actinomycin-D); ≥7 = high-risk (multi-agent EMA-CO or EMA-EP). Brain metastases alone can push a patient into high-risk category.
Reference: Williams Obstetrics, 26th ed.
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