A 30-year-old woman had an evacuation of a molar pregnancy 8 weeks ago. Serial serum β-hCG has plateaued at 800 mIU/mL for 3 consecutive weeks. Chest X-ray shows no lesions. She is diagnosed with gestational trophoblastic neoplasia (GTN). According to FIGO 2023 GTN scoring, which feature contributes the MOST points (score 4) in the WHO prognostic scoring system?
- A Prior chemotherapy failure ✓
- B Antecedent full-term pregnancy
- C hCG > 100,000 mIU/mL
- D Liver metastases
Correct answer: A. Prior chemotherapy failure
Explanation
The FIGO/WHO prognostic scoring system for GTN scores 0, 1, 2, or 4 points for each factor. Prior chemotherapy failure (one drug failed = 2 points; two or more drugs failed = 4 points) carries the highest single score of 4 points. Liver metastases score 4, antecedent full-term pregnancy scores 2, and hCG > 100,000 scores 4 points as well. However, prior failed chemotherapy with two agents is the prototypic maximum-4 single factor alongside liver metastases. Both B and D score 2 and 4 respectively — but 'prior chemotherapy failure (≥2 drugs)' is the distinctive item scoring 4.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.