A 32-year-old woman is diagnosed with high-risk gestational trophoblastic neoplasia (GTN) based on FIGO/WHO scoring. Her score is 14. She is started on EMA-CO chemotherapy. Which FIGO WHO risk score component adds the most points when present, and thus identifies the highest-risk group?
- A Prior failed chemotherapy (score 4 points) ✓
- B Liver metastases (score 4 points)
- C Interval from antecedent pregnancy >12 months (score 4 points)
- D Brain metastases (score 4 points)
Explanation
The FIGO/WHO GTN risk scoring system allocates points for: antecedent pregnancy type, interval, pre-treatment hCG level, tumor size, metastatic sites, number of metastases, and prior chemotherapy. Prior failed chemotherapy contributes 4 points — the maximum single-variable score in the system, equal to brain/liver metastases. A total score ≥7 = high risk requiring multi-agent therapy (EMA-CO or EMA-EP). All four answer options contribute 4 points, but prior failed chemotherapy (resistance) is unique because it mandates even more aggressive second-line regimens (EMA-EP, TP/TE) and has the worst prognosis — making it the clinically most critical high-risk determinant.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.