A 41-year-old woman develops gestational trophoblastic neoplasia after a term delivery. Her interval from the index pregnancy is 5 months, pre-treatment β-hCG is 5,000 mIU/mL, the largest uterine tumour is 2 cm, and there are no metastases. She has not received prior chemotherapy. Using the FIGO/WHO prognostic scoring system, calculate her score and determine management.

• A WHO score 2 — low risk, single-agent methotrexate
• B WHO score 4 — low risk, single-agent methotrexate
• C WHO score 5 — low risk, single-agent methotrexate ✓
• D WHO score 6 — high risk, multi-agent chemotherapy (EMA-CO)

Explanation

FIGO/WHO prognostic score: age ≥ 40 = 1; antecedent term pregnancy = 2; interval from index pregnancy 4–6 months (here 5 months) = 1; pre-treatment β-hCG 1,000–10,000 mIU/mL (here 5,000) = 1; largest tumour < 3 cm = 0; no metastases (site and number) = 0; no prior chemotherapy = 0. Total = 1 + 2 + 1 + 1 = 5. A score ≤ 6 is low-risk and is treated with single-agent chemotherapy (methotrexate or actinomycin-D); a score ≥ 7 is high-risk requiring multi-agent EMA-CO. Note that a score of 6 is still low-risk, so labelling it high-risk is incorrect.

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

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Written and medically reviewed by the StethoPrep medical team.