Oncology

FIGO/WHO 2000 Prognostic Score for GTN Calculator

Q: What counts as prior chemotherapy in this score?

Any prior attempt at antineoplastic therapy for confirmed or presumed GTN that did not achieve remission. This is a poor prognostic factor (2 points) and usually shifts management toward multiagent chemotherapy.

Q: How often should the score be recalculated?

Once, before starting therapy. If the disease becomes resistant, stratification should be reassessed and the patient reclassified as high risk regardless of the original score.

Q: When is surgery indicated in GTN?

In chemotherapy-resistant disease (local resection, hysterectomy), in PSTT/ETT histology, and in cases of massive uterine hemorrhage. Surgery complements rather than replaces chemotherapy.

Q: How should hCG be monitored after treatment?

Weekly until 3 consecutive normal values, then monthly for 6 months, then every 2 months through the end of year 1. Contraception is required for at least 12 months after hCG normalization.

Low vs high risk stratification for gestational trophoblastic neoplasia (GTN)

Primary source: FIGO Oncology Committee. Int J Gynaecol Obstet 2002; 77(3): 285-287

Aleksandr A. Aulov, MD, internal medicine Last clinical review: April 28, 2026

Online calculation

Age (years)

Antecedent pregnancy

Months from index pregnancy

Pretreatment hCG (IU/mL)

Largest tumor/metastasis size (cm)

Site of metastases

Number of metastases

Prior failed chemotherapy

About this score

The FIGO/WHO Prognostic Score for Gestational Trophoblastic Neoplasia (FIGO/WHO 2000) is a prognostic scoring system for gestational trophoblastic neoplasia (GTN): choriocarcinoma, invasive mole, and epithelioid and placental site trophoblastic tumors. It replaced the earlier WHO 1983 and Hammond scoring systems.

The score uses 8 factors: age (< 40 = 0, ≥ 40 = 1), antecedent pregnancy (mole, abortion, term pregnancy), interval from the index pregnancy (months), pretreatment hCG, tumor size, site of metastases, number of metastases, and prior failed chemotherapy. Each factor is scored 0, 1, 2, or 4 points.

Risk stratification: ≤ 6 points = low risk (single-agent chemotherapy with methotrexate or actinomycin D); ≥ 7 points = high risk (multiagent chemotherapy, EMA-CO or similar regimens). With appropriate treatment, cure rates approach 100% for low-risk disease and 80-90% for high-risk disease. FIGO 2024 guidance uses this score as the standard for risk stratification.

When to use

Confirmed GTN (by histology or clinical/laboratory criteria with a persistent hCG plateau or rise).
Risk stratification before starting chemotherapy — choice of single-agent versus multiagent regimen.
Outcome prediction and counseling the patient.
Documenting the clinical rationale for regimen selection.

Clinical example

Case

A 32-year-old woman, 3 months after a complete hydatidiform mole, has a persistent hCG plateau (diagnosis of GTN). hCG 5500 IU/L, uterine tumor 4 cm, lung metastases — 3 lesions of 1 cm each, no prior chemotherapy.

Calculation

Age < 40 (0) + antecedent pregnancy — mole (0) + interval 3 months (0) + hCG 1000–10000 (1) + tumor 3–5 cm (1) + site — lung (0) + 1–4 metastases (1) + no prior chemotherapy (0) = 3 points.

Interpretation and management

Low risk (≤ 6). Management: single-agent chemotherapy with methotrexate (1 mg/kg IM every other day × 4 doses with leucovorin rescue) or actinomycin D. Cycles repeat every 2 weeks until hCG normalization, plus 2–3 consolidation courses. Weekly hCG monitoring. If resistant, switch to multiagent chemotherapy (EMA-CO). Cure rate approaches 100%.

Limitations and cautions

Applies only to GTN — not to other gynecologic malignancies.
The PSTT/ETT histologic subtypes (placental site and epithelioid trophoblastic tumors) respond poorly to chemotherapy regardless of the score and often require surgery.
Availability of specific chemotherapy regimens (e.g., methotrexate with leucovorin per protocol) can vary by country or institution and may require local adaptation.
Does not account for molecular features of the tumor.

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Frequently asked questions

What counts as prior chemotherapy in this score?

Any prior attempt at antineoplastic therapy for confirmed or presumed GTN that did not achieve remission. This is a poor prognostic factor (2 points) and usually shifts management toward multiagent chemotherapy.

How often should the score be recalculated?

Once, before starting therapy. If the disease becomes resistant, stratification should be reassessed and the patient reclassified as high risk regardless of the original score.

When is surgery indicated in GTN?

In chemotherapy-resistant disease (local resection, hysterectomy), in PSTT/ETT histology, and in cases of massive uterine hemorrhage. Surgery complements rather than replaces chemotherapy.

How should hCG be monitored after treatment?

Weekly until 3 consecutive normal values, then monthly for 6 months, then every 2 months through the end of year 1. Contraception is required for at least 12 months after hCG normalization.

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Aleksandr A. Aulov Physician, internal medicine, Sechenov School — independent medical education platform. Calculators are compiled from the original publications and current clinical guidelines. Interpretation thresholds follow the source study unless stated otherwise.

This calculator is intended for healthcare professionals. Do not use it for self-diagnosis or self-treatment. Management decisions are made by the treating clinician based on the full clinical picture of the individual patient.