Prognostic Classification

To develop a new prognostic model for disseminated disease, an international consortium recently collected clinical data on patients receiving platinum-based therapy for metastatic germ cell tumor (Table 8-1 and Figure 8-1 and 8-2).2 Data on 5,202 patients with nonseminomatous germ cell tumor and 660 patients with seminoma were analyzed, and it was found that independent predictors of outcome by univariate analysis included mediastinal primary site; degree of a-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) elevation; and the presence of nonpul-monary visceral metastasis. Using these factors, prognostic categories were derived. Good-risk non-seminomatous patients were those with a testicular or retroperitoneal primary, favorable markers, and no nonpulmonary visceral metastases (an anticipated progression-free survival rate of 90%). Poor-prognosis patients included those patients with mediastinal primary nonseminoma, patients with nonpulmonary visceral metastases, or those with an unfavorable elevation in tumor markers (an anticipated progression-free survival rate of 40%). An intermediate group had an anticipated progressionfree survival rate of 75%. For seminoma, only groups of good and intermediate risk were identified, with these risk categories being differentiated by the absence or presence of nonpulmonary visceral metastases. This classification is now the stan

Table 8-1.

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