Placenta
Gestational trophoblastic disease
Neoplasms
Staging-GTD
Author: Mandolin S. Ziadie, M.D.
Last author update: 1 December 2011
Last staff update: 29 September 2020
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Staging[title] gestational trophoblastic tumors
Table of Contents
AJCC / UICC TNM classification | Prognostic index scores | 2006 FIGO staging | 2006 FIGO stage groupings (TNM classification and risk category) | Additional referencesCite this page: Ziadie MS. Staging-GTD. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/placentastaging.html. Accessed May 30th, 2023.
AJCC / UICC TNM classification
Primary tumor (T):
Regional lymph nodes:
Distant metastasis (M):
TNM descriptors for special circumstances:
- 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:
Stage II tumor extends outside of the uterus, limited to the genital structures:
Stage III tumor extends to the lungs, with or without known genital tract involvement:
Stage IV tumor involves all other metastatic sites:
- 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 II: T2 M0 unknown risk:
Stage III: any T M1a unknown risk:
Stage IV: any T M1b unknown risk:
- 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
