Prognostic Scoring and Outcome of Gestational Trophoblastic Disease Patients

Auttaya Ratanakaew, Phornsawan Wasinghon


Background: Gestational trophoblastic neoplasia (GTN) uses prognostic scores to predict the development of resistance to single-agent chemotherapy. Requiring combination chemotherapy, high-risk patients are defined as those with an International Federation of Gynecology and Obstetrics (FIGO) score ? 7. Treatment at a specialized center based on an appropriate and prompt diagnosis is needed for the reduction of untimely death as well as to improve the survivability of patients. This study aimed to study for classifying definitions of low-risk, high-risk, and ultra-high-risk prognostic scores. Also, the outcomes of gestational trophoblastic patients and brain metastasis have been observed.

Methods: The study was observational design. The medical records of 56 gestational trophoblastic patients who visited the Buddhachinaraj Phitsanulok Hospital between 2012 and 2022 were collected and reviewed. The patients had been classified into three groups: low-risk, high-risk, and ultra-high-risk. The low-risk was stage I - III with a score < 7, while the high-risk was defined as FIGO stage II-III with a score ? 7. Also, a risk score ? 13 was defined as ultra-high risk.

Results: Among the 56 patients in this study, 47 patients were at low-risk, accounting for 83.9%, while nine patients were at high-risk (16.1%). No patient had a score of more than 12, defined as ultra-high-risk. All patients had been alive for at least 10 years after diagnosis with brain metastasis stage IV. The incidence of high-risk GTN patients was displayed in 9/56 (16.1%) with lung and brain metastasis. The high-risk score of GTN with brain metastasis showed an incidence rate of GTN patients among 1/56 (1.78%). The ultra-high-risk group was not presented.

Conclusions: Multimodality treatment has benefits for stage IV patients and high-risk groups. However, ultra-high-risk patients with a prognostic score higher than 12 or ? 13 have slightly increased mortality rates. A high-risk group FIGO stage IV with brain metastasis is alive in this study.

J Clin Gynecol Obstet. 2023;12(2):46-51


Gestational trophoblastic neoplasia; Chemotherapy; Brain metastasis; Craniotomy; Brain radiotherapy

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