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Can the FIGO 2000 scoring system for gestational trophoblastic neoplasia be simplified? A new retrospective analysis from a nationwide dataset

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Title: Can the FIGO 2000 scoring system for gestational trophoblastic neoplasia be simplified? A new retrospective analysis from a nationwide dataset
Authors: Eysbouts, YK
Ottevanger, PB
Massuger, LFAG
IntHout, J
Short, D
Harvey, R
Kaur, B
Sebire, NJ
Sarwar, N
Sweep, FCGJ
Seckl, MJ
Item Type: Journal Article
Abstract: Background Worldwide introduction of the International Fedaration of Gynaecology and Obstetrics (FIGO) 2000 scoring system has provided an effective means to stratify patients with gestational trophoblastic neoplasia to single- or multi-agent chemotherapy. However, the system is quite elaborate with an extensive set of risk factors. In this study, we re-evaluate all prognostic risk factors involved in the FIGO 2000 scoring system and examine if simplification is feasible. Patients and methods Between January 2003 and December 2012, 813 patients diagnosed with gestational trophoblastic neoplasia were identified at the Trophoblastic Disease Centre in London and scored using the FIGO 2000. Multivariable analysis and stepwise logistic regression were carried out to evaluate whether the FIGO 2000 scoring system could be simplified. Results Of the eight FIGO risk factors only pre-treatment serum human chorionic gonadotropin (hCG) levels exceeding 10 000 IU/l (OR = 5.0; 95% CI 2.5–10.4) and 100 000 IU/l (OR = 14.3; 95% CI 4.7–44.1), interval exceeding 7 months since antecedent pregnancy (OR = 4.1; 95% CI 1.0–16.2), and tumor size of over 5 cm (OR = 2.2; 95% CI 1.3–3.6) were identified as independently predictive for single-agent resistance. In addition, increased risk was apparent for antecedent term pregnancy (OR = 3.4; 95% CI 0.9–12.7) and the presence of five or more metastases (OR = 3.5; 95% CI 0.4–30.4), but patient numbers in these categories were relatively small. Stepwise logistic regression identified a simplified risk scoring model comprising age, pretreatment serum hCG, number of metastases, antecedent pregnancy, and interval but omitting tumor size, previous failed chemotherapy, and site of metastases. With this model only 1 out 725 patients was classified different from the FIGO 2000 system. Conclusion Our simplified alternative using only five of the FIGO prognostic factors appears to be an accurate system for discriminating patients requiring single as opposed to multi-agent chemotherapy. Further work is urgently needed to validate these findings.
Issue Date: 28-Apr-2017
Date of Acceptance: 28-Apr-2017
URI: http://hdl.handle.net/10044/1/54189
DOI: https://dx.doi.org/10.1093/annonc/mdx211
ISSN: 0923-7534
Publisher: Oxford University Press (OUP)
Start Page: 1856
End Page: 1861
Journal / Book Title: Annals of Oncology
Volume: 28
Issue: 8
Copyright Statement: This is a pre-copyedited, author-produced PDF of an article accepted for publication in Annals of Oncology following peer review. The version of record Y. K. Eysbouts, P. B. Ottevanger, L. F. A. G. Massuger, J. IntHout, D. Short, R. Harvey, B. Kaur, N. J. Sebire, N. Sarwar, F. C. G. J. Sweep, M. J. Seckl; Can the FIGO 2000 scoring system for gestational trophoblastic neoplasia be simplified? A new retrospective analysis from a nationwide dataset, Annals of Oncology, Volume 28, Issue 8, 1 August 2017, Pages 1856–1861, is available online at: https://dx.doi.org/10.1093/annonc/mdx211
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust
Funder's Grant Number: RDB01 79560
RDB22 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
gestational trophoblastic neoplasia
classification
staging
FIGO
risk factors
PROGNOSTIC-FACTORS
HYDATIDIFORM MOLE
RISK
DISEASE
MANAGEMENT
CLASSIFICATION
EPIDEMIOLOGY
RESISTANCE
DIAGNOSIS
TUMORS
1112 Oncology And Carcinogenesis
Oncology & Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine



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