Patient Profile
Age (years)
<40 years old
(0)
≥40 years old
(1)
Pretreatment hCG (IU/L)
<103
(0)
103-104
(1)
104-105
(2)
>105
(4)
Antecedent Pregnancy
Mole
(0)
Abortion
(1)
Term
(2)
Interval From Index Pregnancy (months)
<4 mos
(0)
4-6 mos
(1)
7-12 mos
(2)
>12 mos
(4)
Largest Tumor Size, including uterus (cm)
<3 cm
(0)
3-5 cm
(1)
>5 cm
(2)
Site of Metastases
Lung
(0)
Spleen
(1)
Kidney
(1)
GI tract
(2)
Liver
(4)
Brain
(4)
Ovary/Tube/Vagina/Broad ligament
Other Distant Metastasis
Number of Metastases Identified
0
(0)
1-4
(1)
5-8
(2)
≥8
(4)
Previous Failed Chemotherapy
No
(0)
Single Drug
(2)
Multiagents
(4)
Prognostic Score
___ / 25
Risk Group
___ risk
FIGO Stage
____