Obstetrics and Gynecology Board Review Pearls of Wisdom

498 Obstetrics and Gynecology Board Review •••

❍ Describe the revised International Federation of Gynecologists and Obstetricians (FIGO) 2000 prognostic
index score for GTD

Prognostic Factor 0 1 2 4

Age (year) ≤ 39 > 39

Antecedent

pregnancy

Hydatidiform mole Abortion Term pregnancy

Intervala <4 months 4–6 months 6–12 months >12 months

Pretreatment hCG

(mIU/mL)

< 1000 1000–10,000 10,000–100,000 >100,000

Largest tumor,

including uterine (cm)

3–4 cm 5 cm or greater

Site of metastases Lung Spleen and

kidney

GI tract Brain and liver

Number of

metastases

0 1–3 4–8 > 8

Prior chemotherapy Single drug Two or more drugs

Total score 0–6 = low risk; 7 or higher = high risk.a

Interval: time in months from end of antecedent pregnancy to chemotherapy.

❍ Describe the management options by stage.
(1) Stage I disease (confined only to uterine corpus):
(a) Patient no longer wishes to preserve fertility—hysterectomy with adjuvant single-agent chemotherapy.
(b) Patient with PSTT—hysterectomy, as these tumors are resistant to chemotherapy.
(c) Patient wishes to preserve fertility—single-agent chemotherapy.
(d) Patient wishes to preserve fertility but tumor resistant to single-agent chemotherapy—combination
chemotherapy.
(2) Stage II (metastasis to pelvis and vagina) and III (metastasis to lungs):
(e) Low-risk patient—single-agent chemotherapy.
(f ) High-risk patient—combination chemotherapy.
(3) Stage IV (distant metastasis).
All these patients should be treated with combination chemotherapy and the selective use of radiation therapy and
surgery.