According to the FIGO 2000 prognostic scoring system for gestational trophoblastic neoplasia, a score of ≥7 classifies the patient as high-risk requiring multi-agent chemotherapy. Which of the following factor combinations would score the MOST points?

• A Age 22, term pregnancy, pre-treatment hCG 8000 IU/L, tumour size 3 cm, lung metastases, no prior chemotherapy, interval from index pregnancy 4 months
• B Age 42, non-molar pregnancy, pre-treatment hCG >100,000 IU/L, tumour size >5 cm, brain metastases, two prior chemotherapy regimens, interval 18 months ✓
• C Age 35, hydatidiform mole, pre-treatment hCG 5000 IU/L, tumour size 4 cm, liver metastases, one prior chemotherapy regimen, interval 3 months
• D Age 18, abortion, pre-treatment hCG 50,000 IU/L, tumour size 4 cm, lung metastases, no prior chemotherapy, interval 8 months

Explanation

FIGO GTN scoring assigns points for: age ≥40 (1 pt), antecedent non-molar pregnancy (1 pt for abortion, 2 for term), hCG >100,000 (4 pts), tumour size ≥5 cm (2 pts), site of metastases (liver/GI = 2 pts each; brain = 4 pts), number of metastases, and prior chemotherapy (≥2 regimens = 4 pts). Option B accumulates points from age ≥40 (1), term pregnancy (2), hCG >100,000 (4), size ≥5 cm (2), brain metastases (4), ≥2 prior regimens (4) = at minimum 17 points, the highest score among options.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.