Testicular Cancer:Prognostic staging system for metastatic germ cell cancer

International Germ Cell Cancer Collaborative Group (IGCCCG)•Devised a prognostic factor–based staging

system for metastatic germ cell cancer that includes:

a. good- and intermediate-prognosis seminoma

b. good-, intermediate-, and poor-prognosis non-seminomatous germ cell tumors

IGCCCG staging system for metastatic germ cell cancer

Seminoma NSGCT

•Good•5-year progression free survival•All factors listedpresent:

•90% of patients•86%•Any primary site; no nonpulmonary visceral metastases; normal AFP; Any hCG or LDH

•56% of patients•92%•Testis or retroperitoneal primary site; no nonpulmonary visceral metastases; AFP <1000 ng/mL; hCG <5000 mIU/L; andLDH <1.5 normal upper limit (S1)

•Intermediate•5-year progression free survival•All factors listedpresent:

•10% of patients•73%•Any primary site; nonpulmonary visceral metastases present; normal AFP; Any hCG or LDH

•28% of patients•80%•Testis or retroperitoneal primary site; no nonpulmonary visceral metastases; AFP 1000–9999 ng/mL or hCG 5000–49999 mIU/mL; LDH 1.5–10 normal upper limit (S2)

•Poor•5-year progression free survival•All factors listedpresent:

No patients classifi edas poor prognosis

•16% of patients•48%•Mediastinal primary; nonpulmonaryvisceral metastases present; AFP>10,000 ng/mL or hCG >50,000mIU/L; LDH >10 normal upperlimit (S3)

Primary therapy of testicular cancer is based on the following:

•Histology (seminoma vs. NSGCT)•Clinical TNM stage•International Germ Cell Cancer

Collaborative Group (IGCCCG) classification (good, intermediate, or poor risk)