Gestational trophoblastic disease



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Last staff update: 8 May 2024 (update in progress)

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PubMed Search: Staging[title] gestational trophoblastic tumors

Mandolin S. Ziadie, M.D.
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Cite this page: Ziadie MS. Staging-GTD. website. Accessed May 19th, 2024.
AJCC / UICC TNM classification
Primary tumor (T):
  • TX: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • T1 (I): tumor confined to uterus
  • T2 (II): tumor extends to other genital structures (ovary, tube, vagina and broad ligaments) by metastasis or direct extension

Regional lymph nodes:
  • No regional nodal designation (N classification) in the staging of gestational trophoblastic tumors
  • Nodal involvement is classified as metastatic M1b disease

Distant metastasis (M):
  • M0: no distant metastasis
  • M1: distant metastasis
  • M1a (III): lung metastasis
  • M1b (IV): all other distant metastasis (direct invasion or metastasis to nongenital structures)

TNM descriptors for special circumstances:
  • "m" suffix: multiple primary tumors in a single site (recorded in parentheses)
  • "y" prefix: classification performed during / after initial therapy
  • "r" prefix: recurrent tumor after documented disease free interval
  • "a" prefix: stage determined at autopsy
  • Residual tumor (R)
    • Rx: cannot be assessed
    • R0: no residual tumor
    • R1: microscopic residual tumor
    • R2: macroscopic residual tumor
Prognostic index scores
Factors and scoring:
  • Age: 0 if < 40, 1 if age 40 or more
  • Antecedent pregnancy: 0 if hydatidiform mole, 1 if abortion and 2 if term pregnancy
  • Interval months from index pregnancy: 0 if < 4 months, 1 if 4 - 6 months, 2 if 7 - 12 months and 4 if > 12 months
  • Pretreatment hCG: 0 if < 1,000, 1 if 1,000 - 9,999, 2 if 10,000 - 99,999 and 4 if 100,000 or more
  • Largest tumor size, including uterus: 0 if < 3 cm, 1 if 3 - 5 cm and 2 if > 5 cm
  • Site of metastases: 0 if lung, 1 if spleen or kidney, 2 if GI tract and 4 if brain or liver
  • Number of metastases identified: 1 if 1 - 4, 2 if 5 - 8 and 4 if > 8
  • Previous failed chemotherapy: 2 if single drug, 4 if 2+ drugs

  • Low risk: score of 6 or less (usually treat with single agent chemotherapy)
  • High risk: score of 7 or more (usually treat with combined, multiple agent chemotherapy)
2006 FIGO staging
Stage I tumor confined to the uterus:
  • IA stage I with low risk prognostic score
  • IB stage I with high risk prognostic score

Stage II tumor extends outside of the uterus, limited to the genital structures:
  • IIA stage II with low risk prognostic score
  • IIB stage II with high risk prognostic score

Stage III tumor extends to the lungs, with or without known genital tract involvement:
  • IIIA stage III with low risk prognostic score
  • IIIB stage III with high risk prognostic score

Stage IV tumor involves all other metastatic sites:
  • IVA stage IV with low risk prognostic score
  • IVB stage IV with high risk prognostic score
2006 FIGO stage groupings (TNM classification and risk category)
Stage I: T1 M0 unknown risk factors:
  • Stage IA: T1 M0 low risk
  • Stage IB: T1 M0 high risk

Stage II: T2 M0 unknown risk:
  • Stage IIA: T2 M0 low risk
  • Stage IIB: T2 M0 high risk

Stage III: any T M1a unknown risk:
  • Stage IIIA: any T M1a low risk
  • Stage IIIB: any T M1a high risk

Stage IV: any T M1b unknown risk:
  • Stage IVA: any T M1b low risk
  • Stage IVB: any T M1b high risk
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