Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

Table 1 International Federation of Gynecology and Obstetrics/World Health Organization staging and classification of gestational trophoblastic disease

GTN: FIGO staging and classification (Washington, 2000)
FIGO anatomic staging
Stage I: Disease confined to the uterus
Stage II: GTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament)
Stage III: GTN extends to the lungs, with or without known genital tract involvement
Stage IV: All other metastatic sites
Modified WHO prognostic scoring system as adapted by FIGO
Prognostic factors	Score
	0	1	2	4
Age	< 40	≥ 40	-	-
Antecedent gestation	Mole	Abortion	Term	-
Interval (mo)	< 4	4-6	7-12	> 12
Pretreatment serum hCG (IU/L)	< 103	103 to < 104	104 to < 105	> 105
Largest tumor size (including uterus)	< 3	3 to 4	≥ 5	-
Site of metastases	Lung	spleen, kidney	gastro intestinal tract	brain, liver
Number of metastases	-	1-4	5-8	> 8
Previous failed chemotherapy	-	-	single drug	2 or more drugs

Interval (in months) between the end of antecedent gestation (when known) and symptom onset. FIGO: International Federation of Gynecology and Obstetrics; WHO: World Health Organization; GTN: Gestational trophoblastic neoplasia; hCG: Human chorionic gonadotropin.