A retrospective comparison of current and proposed staging and scoring systems for persistent gestational...

It is widely accepted that patients with persistent gestational trophoblastic disease (GTD) are best managed by stratifying their treatment according to recognized adverse prognostic features. We retrospectively evaluated 201 patients who had received chemotherapy for persistent low or high risk GTD at the Sheffield Center according to criteria used in established and proposed WHO scoring and FIGO staging systems to identify the numbers of patients in each risk category, the treatment they would receive, chemotherapy resistance patterns, and eventual outcome. The systems were broadly comparable and chemotherapy resistance was always greater in the high-risk groups (at least 33%), particularly when patients were divided into just two risk categories. Such a categorization led to fewer patients (less than 15%) falling into high-risk groupings, but outcome was not compromised. Mortality (3 deaths) was associated with high risk categorization in all systems evaluated. A proposal to combine revised FIGO staging and modified WHO scoring systems, with two risk groupings, is realistic and practicable.