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Journal of Clinical Oncology, Vol 15, 594-603, Copyright © 1997 by American Society of Clinical Oncology

ARTICLES

International Germ Cell Consensus Classification: a prognostic factor- based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group


PURPOSE: Cisplatin-containing chemotherapy has dramatically improved the outlook for patients with metastatic germ cell tumors (GCT), and overall cure rates now exceed 80%. To make appropriate risk-based decisions about therapy and to facilitate collaborative trials, a simple prognostic factor-based staging classification is required. MATERIALS: Collaborative groups from 10 countries provided clinical data on patients with metastatic GCT treated with cisplatin-containing chemotherapy. Multivariate analyses of prognostic factors for progression and survival were performed and models were validated on an independent data set. RESULTS: Data were available on 5,202 patients with nonseminomatous GCT (NSGCT) and 660 patients with seminoma. Median follow-up time was 5 years. For NSGCT the following independent adverse factors were identified: mediastinal primary site; degree of elevation of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), and lactic dehydrogenase (LDH); and presence of nonpulmonary visceral metastases (NPVM), such as liver, bone, and brain. For seminoma, the predominant adverse feature was the presence of NPVM. Integration of these factors produced the following groupings: good prognosis, comprising 60% of GCT with a 91% (89% to 93%) 5-year survival rate; intermediate prognosis, comprising 26% of GCT with a 79% (75% to 83%) 5- year survival rate; and poor prognosis, comprising 14% of GCT (all with NSGCT) with a 48% (42% to 54%) 5-year survival rate. CONCLUSION: An easily applicable, clinically based, prognostic classification for GCT has been agreed on between all the major clinical trial groups who are presently active worldwide. This should be used in clinical practice and in the design and reporting of clinical trials to aid international collaboration and understanding.
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H. Nakajima, M. Oki, S. Matsukura, M. Nakamura, M. Tokunaga, and K. Ando
Germ Cell Tumors: CASE 1. Intraocular Metastases From Testicular Cancer
J. Clin. Oncol., May 1, 2004; 22(9): 1753 - 1755.
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D. Gholam, J.-P. Lotz, D. Atallah, and C. Theodore
Germ Cell Tumors: CASE 2. Unusual Course of Pure Testicular Seminoma
J. Clin. Oncol., May 1, 2004; 22(9): 1755 - 1756.
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B. P. Schneider, K. A. Kesler, J. A. Brooks, C. Yiannoutsos, and L. H. Einhorn
Outcome of Patients With Residual Germ Cell or Non-Germ Cell Malignancy After Resection of Primary Mediastinal Nonseminomatous Germ Cell Cancer
J. Clin. Oncol., April 1, 2004; 22(7): 1195 - 1200.
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M. J. Duffy, C. Duggan, R. Keane, A. D.K. Hill, E. McDermott, J. Crown, and N. O'Higgins
High Preoperative CA 15-3 Concentrations Predict Adverse Outcome in Node-Negative and Node-Positive Breast Cancer: Study of 600 Patients with Histologically Confirmed Breast Cancer
Clin. Chem., March 1, 2004; 50(3): 559 - 563.
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D. Bajorin
The Phase III Candidate: Can We Improve the Science of Selection?
J. Clin. Oncol., January 15, 2004; 22(2): 211 - 213.
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A. C. Donadio, R. J. Motzer, D. F. Bajorin, P. W. Kantoff, J. Sheinfeld, J. Houldsworth, R. S.K. Chaganti, and G. J. Bosl
Chemotherapy for Teratoma With Malignant Transformation
J. Clin. Oncol., December 1, 2003; 21(23): 4285 - 4291.
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R. J. Motzer and J. Sheinfeld
Poor-Risk Testicular Cancer and High-Dose Chemotherapy
J. Clin. Oncol., November 15, 2003; 21(22): 4073 - 4074.
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H.-J. Schmoll, C. Kollmannsberger, B. Metzner, J.T. Hartmann, N. Schleucher, P. Schoffski, J. Schleicher, O. Rick, J. Beyer, D. Hossfeld, et al.
Long-Term Results of First-Line Sequential High-Dose Etoposide, Ifosfamide, and Cisplatin Chemotherapy Plus Autologous Stem Cell Support for Patients With Advanced Metastatic Germ Cell Cancer: An Extended Phase I/II Study of the German Testicular Cancer Study Group
J. Clin. Oncol., November 15, 2003; 21(22): 4083 - 4091.
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D. A. Vaena, R. Abonour, and L. H. Einhorn
Long-Term Survival After High-Dose Salvage Chemotherapy for Germ Cell Malignancies With Adverse Prognostic Variables
J. Clin. Oncol., November 15, 2003; 21(22): 4100 - 4104.
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J. Oldenburg, G. C. Alfsen, H. H. Lien, N. Aass, H. Waehre, and S. D. Fossa
Postchemotherapy Retroperitoneal Surgery Remains Necessary in Patients With Nonseminomatous Testicular Cancer and Minimal Residual Tumor Masses
J. Clin. Oncol., September 1, 2003; 21(17): 3310 - 3317.
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J. Miyazaki, K. Kawai, H. Hayashi, M. Onozawa, S. Tsukamoto, N. Miyanaga, S. Hinotsu, T. Shimazui, and H. Akaza
The Limited Efficacy of Methotrexate, Actinomycin D and Cisplatin (MAP) for Patients with Advanced Testicular Cancer
Jpn. J. Clin. Oncol., August 1, 2003; 33(8): 391 - 395.
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M. Mazumdar, J. Bacik, S. K. Tickoo, D. Dobrzynski, A. Donadio, D. Bajorin, R. Motzer, V. Reuter, and G. J. Bosl
Cluster Analysis of p53 and Ki67 Expression, Apoptosis, Alpha-Fetoprotein, and Human Chorionic Gonadotrophin Indicates a Favorable Prognostic Subgroup Within the Embryonal Carcinoma Germ Cell Tumor
J. Clin. Oncol., July 15, 2003; 21(14): 2679 - 2688.
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A. Madani, K. Kemmer, C. Sweeney, C. Corless, T. Ulbright, M. Heinrich, and L. Einhorn
Expression of KIT and epidermal growth factor receptor in chemotherapy refractory non-seminomatous germ-cell tumors
Ann. Onc., June 1, 2003; 14(6): 873 - 880.
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T. Powles, M. Bower, G. Daugaard, J. Shamash, A. De Ruiter, M. Johnson, M. Fisher, J. Anderson, S. Mandalia, J. Stebbing, et al.
Multicenter Study of Human Immunodeficiency Virus-Related Germ Cell Tumors
J. Clin. Oncol., May 15, 2003; 21(10): 1922 - 1927.
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R.A. Huddart, A. Norman, M. Shahidi, A. Horwich, D. Coward, J. Nicholls, and D.P. Dearnaley
Cardiovascular Disease as a Long-Term Complication of Treatment for Testicular Cancer
J. Clin. Oncol., April 15, 2003; 21(8): 1513 - 1523.
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S. D. Fossa, R. de Wit, J. T. Roberts, P. M. Wilkinson, P. H.M. de Mulder, G. M. Mead, P. Cook, L. de Prijck, S. Stenning, N. K. Aaronson, et al.
Quality of Life in Good Prognosis Patients With Metastatic Germ Cell Cancer: A Prospective Study of the European Organization for Research and Treatment of Cancer Genitourinary Group/Medical Research Council Testicular Cancer Study Group (30941/TE20)
J. Clin. Oncol., March 15, 2003; 21(6): 1107 - 1118.
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K. Kawai, J. Miyazaki, S. Tsukamoto, S. Hinotsu, K. Hattori, T. Shimazui, and H. Akaza
Paclitaxel, Ifosfamide and Cisplatin Regimen is Feasible for Japanese Patients with Advanced Germ Cell Cancer
Jpn. J. Clin. Oncol., March 1, 2003; 33(3): 127 - 131.
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G. Calaminus, D.T. Schneider, J.P.M. Bokkerink, H. Gadner, D. Harms, R. Willers, and U. Gobel
Prognostic Value of Tumor Size, Metastases, Extension into Bone, and Increased Tumor Marker in Children With Malignant Sacrococcygeal Germ Cell Tumors: A Prospective Evaluation of 71 Patients Treated in the German Cooperative Protocols Maligne Keimzelltumoren (MAKEI) 83/86 and MAKEI 89
J. Clin. Oncol., March 1, 2003; 21(5): 781 - 786.
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J.A. Christian, R.A. Huddart, A. Norman, M. Mason, S. Fossa, N. Aass, E.J. Nicholl, D.P. Dearnaley, and A. Horwich
Intensive Induction Chemotherapy With CBOP/BEP in Patients With Poor Prognosis Germ Cell Tumors
J. Clin. Oncol., March 1, 2003; 21(5): 871 - 877.
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D. W. George, R. S. Foster, R. A. Hromas, K. A. Robertson, G. H. Vance, T. M. Ulbright, T. A. Gobbett, D. J. Heiber, N. A. Heerema, H. C. Ramsey, et al.
Update on Late Relapse of Germ Cell Tumor: A Clinical and Molecular Analysis
J. Clin. Oncol., January 1, 2003; 21(1): 113 - 122.
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T. Kamoto, S. Satomura, T. Yoshiki, Y. Okada, F. Henmi, H. Nishiyama, T. Kobayashi, A. Terai, T. Habuchi, and O. Ogawa
Lectin-reactive {alpha}-Fetoprotein (AFP-L3%) Curability and Prediction of Clinical Course after Treatment of Non-seminomatous Germ Cell Tumors
Jpn. J. Clin. Oncol., November 1, 2002; 32(11): 472 - 476.
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J. A. Gietema, M. T. Meinardi, D. T. Sleijfer, H. J. Hoekstra, and W. T. A. van der Graaf
Routine chest X-rays have no additional value in the detection of relapse during routine follow-up of patients treated with chemotherapy for disseminated non-seminomatous testicular cancer
Ann. Onc., October 1, 2002; 13(10): 1616 - 1620.
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R.T.D. Oliver, J. Shamash, D.M. Berney, F. Mayer, A.-M. Kersemaekers, J. W. Oosterhuis, C. Bokemeyer, and L. H.J. Looijenga
p53 and MDM2 in Germ Cell Cancer Treatment Response
J. Clin. Oncol., September 15, 2002; 20(18): 3928 - 3929.
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C. Sturgeon
Practice Guidelines for Tumor Marker Use in the Clinic
Clin. Chem., August 1, 2002; 48(8): 1151 - 1159.
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J. T. Hartmann, C. R. Nichols, J.-P. Droz, A. Horwich, A. Gerl, S. D. Fossa, J. Beyer, J. Pont, L. Kanz, L. Einhorn, et al.
Prognostic variables for response and outcome in patients with extragonadal germ-cell tumors
Ann. Onc., July 1, 2002; 13(7): 1017 - 1028.
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L. H. Einhorn
Inaugural Article: Curing metastatic testicular cancer
PNAS, April 2, 2002; 99(7): 4592 - 4595.
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C. Bokemeyer, C. R. Nichols, J.-P. Droz, H.-J. Schmoll, A. Horwich, A. Gerl, S. D. Fossa, J. Beyer, J. Pont, L. Kanz, et al.
Extragonadal Germ Cell Tumors of the Mediastinum and Retroperitoneum: Results From an International Analysis
J. Clin. Oncol., April 1, 2002; 20(7): 1864 - 1873.
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D. J. Vaughn, G. A. Gignac, and A. T. Meadows
Long-Term Medical Care of Testicular Cancer Survivors
Ann Intern Med, March 19, 2002; 136(6): 463 - 470.
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A.-M. F. Kersemaekers, F. Mayer, M. Molier, P. C. van Weeren, J. W. Oosterhuis, C. Bokemeyer, and L. H.J. Looijenga
Role of P53 and MDM2 in Treatment Response of Human Germ Cell Tumors
J. Clin. Oncol., March 15, 2002; 20(6): 1551 - 1561.
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