According to the FIGO 2000 scoring system for gestational trophoblastic neoplasia (GTN), a patient with a 9-month antecedent pregnancy interval, hCG of 80,000 IU/L, 4 metastases (including 2 liver metastases), and no prior chemotherapy has a score of:
- A 6 (low risk — single-agent methotrexate)
- B 9 (high risk — multi-agent EMA-CO regimen) ✓
- C 12 (ultra-high risk — intensive chemotherapy)
- D 7 (borderline — single or multi-agent based on centre preference)
Correct answer: B. 9 (high risk — multi-agent EMA-CO regimen)
Explanation
FIGO 2000 GTN scoring: antecedent pregnancy interval 7–12 months scores 1; hCG 10,000–100,000 scores 2; number of metastases 4 scores 2; liver metastasis site scores 2 each (2 liver mets = 4); prior chemotherapy scores 0. Total = 1 + 2 + 2 + 4 = 9. A score ≥7 defines high-risk GTN, requiring multi-agent EMA-CO (etoposide-methotrexate-actinomycin D alternating with cyclophosphamide-oncovin) chemotherapy. Single-agent methotrexate is used for low-risk GTN (score ≤6). Cure rates exceed 90% even in high-risk disease.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.