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Staging of gestational trophoblastic disease

Trophoblastic diseases are staged according to FIGO (The International Federation of Gynecology and Obstetrics) and WHO (World Health Organization) risk scores.

Staging according to FIGO

Stage I: The tumor does not extend beyond the uterus.  


Stage II: The tumor extends to the adnexa, parametria, or vagina.


Stage III: Lung metastases. Only lung metastases visible on conventional lung X-ray are included in the scoring system. Small metastases visible only on CT are not included, unless there are many of them. 

Stage IV: Metastases to other localization.

WHO risk score
Factors 0 1 2 4
Age < 40
> 40
Pregnancy Molar Abortion Full-term  
Interval*  < 4 4-6 7-12 > 12
Serum h-CG (lU/L)** < 103 103-104 104-105 > 105
Largest tumor (cm)***   3-5 > 5  
Metastases localization  Lung****/vaginal Spleen/kidney Intestines Brain/liver
Number of metastases  0 1-4 4-8 > 8
Previous chemotherapy     1 drug Multiple drugs

*   The number of months from last finished pregnancy to start of chemotherapy

** hCG value at the time of initiation of treatment

*** Including tumor in uterus

**** Lung metastases are assessed on chest X-ray, not on CT

***** All metastases should be counted, regardless of localization

Low risk group: <=6

  • Non-metastatic: Stage I
  • Metastatic: > Stage I

High risk group: > 6

Placental-site trophoblastic tumors are a special disease group which are only classified according to FIGO stage.   

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