Integration of immuno-nutritional status into International Federation of Gynecology and Obstetrics risk stratification to predict chemotherapy response and survival in gestational trophoblastic neoplasia.

OBJECTIVES: The International Federation of Gynecology and Obstetrics score is widely used to predict chemotherapy resistance in gestational trophoblastic neoplasia, but its ability to predict survival is limited. This study aimed to identify factors associated with complete response and overall survival, and to assess whether integrating immuno-nutritional markers improves the prognostic performance of the International Federation of Gynecology and Obstetrics risk score. METHODS: A retrospective cohort study at a national cancer center in Peru included patients with gestational trophoblastic neoplasia treated with chemotherapy between 2005 and 2019. International Federation of Gynecology and Obstetrics score, body mass index, hemoglobin, neutrophil-to-lymphocyte ratio, and prognostic nutritional index were analyzed in relation to complete response to first-line chemotherapy and overall survival, using logistic regression and Cox models; variables independently associated with both outcomes were integrated into a composite immuno-nutritional International Federation of Gynecology and Obstetrics model. Model performance was assessed using receiver operating characteristic curves, and survival analyses were performed using the Kaplan-Meier method. RESULTS: A total of 160 patients were included; in multi-variable analyses, prognostic nutritional index and International Federation of Gynecology and Obstetrics score were independently associated with complete response (p =.012 and p =.02) and overall survival (p =.013 and p =.049). The immuno-nutritional International Federation of Gynecology and Obstetrics model demonstrated improved discrimination for complete response compared with the International Federation of Gynecology and Obstetrics score alone (area under the curve 0.719 vs 0.633), with higher sensitivity (71.6% vs 61.5%) and specificity (74.3% vs 62.9%); for overall survival, the immuno-nutritional International Federation of Gynecology and Obstetrics model showed higher sensitivity (96.6% vs 72.4%) but lower specificity (45.0% vs 61.8%) and a slightly lower area under the curve (0.691 vs 0.710). Risk stratification using receiver operating characteristic-derived cutoffs identified a high-risk group with significantly worse survival (hazard ratio 19.1, 95% confidence interval 2.60 to 141, p <.001). CONCLUSIONS: Prognostic nutritional index and International Federation of Gynecology and Obstetrics score were independently associated with treatment response and survival in gestational trophoblastic neoplasia. By integrating the International Federation of Gynecology and Obstetrics and prognostic nutritional index, the immuno-nutritional International Federation of Gynecology and Obstetrics model improved discrimination for predicting complete response to first-line chemotherapy and enhanced identification of patients at higher risk of adverse outcomes, providing a simple and accessible approach to refine risk stratification.