Department of Obstetrics and Gynecology.
Department of Medical Oncology.
Ann Oncol. 2017 Aug 1;28(8):1856-1861. doi: 10.1093/annonc/mdx211.
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.
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.
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.
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.
国际妇产科联合会（FIGO）2000 评分系统在全球范围内的引入，为妊娠滋养细胞肿瘤患者的单药或联合化疗分层提供了有效手段。然而，该系统非常复杂，涉及广泛的风险因素。本研究重新评估了 FIGO 2000 评分系统中涉及的所有预后风险因素，并探讨了简化的可行性。
2003 年 1 月至 2012 年 12 月期间，伦敦滋养细胞疾病中心共确诊 813 例妊娠滋养细胞肿瘤患者，采用 FIGO 2000 评分系统进行评分。采用多变量分析和逐步逻辑回归评估 FIGO 2000 评分系统是否可以简化。
在 8 个 FIGO 风险因素中，仅治疗前血清人绒毛膜促性腺激素（hCG）水平超过 10000IU/L（OR=5.0；95%CI 2.5-10.4）和 100000IU/L（OR=14.3；95%CI 4.7-44.1）、前次妊娠后间隔超过 7 个月（OR=4.1；95%CI 1.0-16.2）和肿瘤直径超过 5cm（OR=2.2；95%CI 1.3-3.6）被确定为单药耐药的独立预测因素。此外，前次足月妊娠（OR=3.4；95%CI 0.9-12.7）和存在 5 个或更多转移灶（OR=3.5；95%CI 0.4-30.4）的风险增加，但这些类别的患者数量相对较少。逐步逻辑回归确定了一个简化的风险评分模型，包括年龄、治疗前血清 hCG、转移灶数量、前次妊娠和间隔时间，但不包括肿瘤大小、先前化疗失败和转移灶部位。使用该模型，只有 1/725 名患者的分类与 FIGO 2000 系统不同。
我们使用 FIGO 预后因素中的 5 个因素简化的替代方案，似乎是一种准确的系统，可以区分需要单药与联合化疗的患者。迫切需要进一步的工作来验证这些发现。
