Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models

Abstract

Summary: The FIGO 2000 Prognostic Scoring System is a global standard for prognostication in patients with gestational trophoblastic neoplasia (GTN). However, the system has not been updated in over 20 years, and in clinical practice it has several critical limitations, including inadequate assessment of single-agent chemotherapy resistance and overuse in unsuitable clinical scenarios. This review critically examines these shortcomings and summarizes recent efforts to refine the system. After identifying its limitations, we propose novel refinements: instead of relying on a single system to address multiple clinical objectives, we advocate for specialized scoring models, each tailored to a specific clinical goal. This approach simplifies and enhances the effectiveness of prognostic assessments. Additionally, biological and genetic markers must be integrated into these models to improve accuracy. Looking ahead, we emphasize the need for advanced technologies and multicentre collaboration to build more personalized and adaptive GTN management frameworks, ultimately improving clinical practice and outcomes. Funding: This work was supported by the National Key R&D Program of China (2023YFC2705802) and National High Level Hospital Clinical Research Funding (2022-PUMCH-C-058).

Keywords

• FIGO 2000
• Gestational trophoblastic neoplasia
• Prediction
• Prognostication
• Resistance