Comparison of the Choriocarcinoma Diagnostic Score and FIGO 2000 Risk Classification in Gestational Trophoblastic Neoplasia: Implications for Treatment Outcomes

Abstract

Synopsis: In the diagnosis of invasive mole or choriocarcinoma, histological confirmation is often difficult, and clinical diagnosis is made using the Japanese choriocarcinoma scoring system or the FIGO 2000 risk classification. These two diagnostic systems generally show good concordance. However, differences in scoring criteria may cause diagnostic discrepancies, and the outcomes of such cases remain unclear. This study examined 273 patients with gestational trophoblastic neoplasia (GTN) treated at our institution between 1991 and 2023 to evaluate the correlation between the two diagnostic methods and to assess treatment outcomes in discordant cases. A strong positive correlation was observed between the two classifications, with a diagnostic concordance rate of 92.2%. The concordance rate between pathological diagnosis and the Japanese choriocarcinoma scoring system was 92.7%. Treatment strategies were determined according to pathological diagnosis or the Japanese scoring system. The overall survival rate was 84.9% in choriocarcinoma and 99.5% in non-choriocarcinoma. Notably, all patients with clinical choriocarcinoma and low-risk GTN achieved 100% survival with multi-agent chemotherapy, and those with clinical invasive mole and high-risk GTN achieved 100% survival with single-agent chemotherapy. In conclusion, the Japanese choriocarcinoma scoring system is more consistent with pathological diagnosis and may be more suitable for treatment selection.