Abstract: Gestational trophoblastic neoplasia (GTN) can be classified into low-risk and high-risk patients based on the FIGO staging and scoring system. High-risk patients have a higher risk of resistance to single-agent chemotherapy and require combination chemotherapy. However, there are still some high-risk patients who develop resistance to combination chemotherapy or experience recurrence after cure. These patients exhibit strong heterogeneity, and subsequent treatment poses significant challenges, attracting considerable attention in recent years. Therefore, this article provides a review of the risk factors and treatment strategies for high-risk resistant and recurrent GTN patients, aiming to provide a basis for early identification of high-risk patients and their precise treatment.