6 Staging and Classification Systems

It is universally recognized that an accurate and precise staging and classification system for gestational trophoblastic neoplasia (GTN) is essential to enable clinicians to assess the prognosis or the risk of patients, to individualize and to optimize their treatment. There have been a variety of staging and classification systems developed by different centres and some are still being used. This makes meaningful comparison of treatment results and evaluation of new treatment protocols difficult and hampers the improvement in the management of the disease. During the 2000 Fédération Internationale de Gynéologie et d’Obstétrique (FIGO) Oncology Committee meeting held in Washington, a revised staging system was proposed and the details of the revised FIGO staging (Table 6.1) were published in 2002 [1]. It was also recommended that gestational trophoblastic neoplasia (GTN) should replace terms like gestational trophoblastic tumor, persistent gestational trophoblastic disease (GTD), residual GTD and malignant GTD. Also, placental site and epithelioid trophoblastic tumours were specifically excluded. Other new features of this staging system are the recommendation of the investigative tools for staging and the definition of metastases. This new staging system for GTN incorporates the classical anatomical staging with other prognostic indicators identified by Bagshawe [2] and others [3-5] and which have been documented to be clinically useful in managing patients with GTN. In this chapter, we shall review the historical background leading to the formulation of the 2000 FIGO staging and we shall try to compare its effectiveness in prognostic prediction with that of the World Health Organization (WHO) scoring system.