The classification of the International Germ Cell Cancer Collaborative Group (IGCCCG) plays a pivotal role in the management of metastatic germ cell tumors but relies on data of patients treated between 1975 and 1990.
Data on 9,728 men with metastatic nonseminomatous germ cell tumors treated with cisplatin- and etoposide-based first-line chemotherapy between 1990 and 2013 were collected from 30 institutions or collaborative groups in Europe, North America, and Australia. Clinical trial and registry data were included. Primary end points were progression-free survival (PFS) and overall survival (OS). The survival estimates were updated for the current era. Additionally, a novel prognostic model for PFS was developed in 3,543 patients with complete information on potentially relevant variables. The results were validated in an independent data set.
Compared with the original IGCCCG publication, 5-year PFS remained similar in patients with good prognosis with 89% (87%-91%) versus 90% (95% CI, 89 to 91), but the 5-year OS increased from 92% (90%-94%) to 96% (95%-96%). In patients with intermediate prognosis, PFS remained similar with 75% (71%-79%) versus 78% (76%-80%) and the OS increased from 80% (76%-84%) to 89% (88%-91%). In patients with poor prognosis, the PFS increased from 41% (95% CI, 35 to 47) to 54% (95% CI, 52 to 56) and the OS from 48% (95% CI, 42 to 54) to 67% (95% CI, 65 to 69). A more granular prognostic model was developed and independently validated. This model identified a new cutoff of lactate dehydrogenase at a 2.5 upper limit of normal and increasing age and presence of lung metastases as additional adverse prognostic factors. An online calculator is provided (https://www.eortc.org/IGCCCG-Update).
The IGCCCG Update model improves individual prognostication in metastatic nonseminomatous germ cell tumors. Increasing age and lung metastases add granularity to the original IGCCCG classification as adverse prognostic factors.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2021 Apr 06 [Epub ahead of print]
Silke Gillessen, Nicolas Sauvé, Laurence Collette, Gedske Daugaard, Ronald de Wit, Costantine Albany, Alexey Tryakin, Karim Fizazi, Olof Stahl, Jourik A Gietema, Ugo De Giorgi, Fay H Cafferty, Aaron R Hansen, Torgrim Tandstad, Robert A Huddart, Andrea Necchi, Christopher J Sweeney, Xavier Garcia-Del-Muro, Daniel Y C Heng, Anja Lorch, Michal Chovanec, Eric Winquist, Peter Grimison, Darren R Feldman, Angelika Terbuch, Marcus Hentrich, Carsten Bokemeyer, Helene Negaard, Christian Fankhauser, Jonathan Shamash, David J Vaughn, Cora N Sternberg, Axel Heidenreich, Jörg Beyer, International Germ Cell Cancer Classification Update Consortium
Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland., European Organisation for Research and Treatment of Cancer, Brussels, Belgium., Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN., N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation., Institut Gustave Roussy, University of Paris Saclay, Villejuif, France., Department of Oncology, Skåne University Hospital, Lund, Sweden., University Medical Center Groningen, Groningen, the Netherlands., Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy and the Italian Germ Cell Cancer Group (IGG)., Medical Research Council Clinical Trials Unit, University College London (UCL), London, United Kingdom., Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., The Cancer Clinic, St Olavs University Hospital and Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway., Institute of Cancer Research, Sutton, United Kingdom., Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Current Affiliation: Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy., Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA., Catalan Institute of Oncology, IDIBELL Institute of Research, University of Barcelona, Barcelona, Spain., Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada., Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland., 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia., Division of Medical Oncology, Western University and London Health Sciences Centre, London, Ontario, Canada., Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, Australia., Memorial Sloan Kettering Cancer Center, New York, NY., Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria., Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany., Department of Oncology, Hematology and BMT with Section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Oncology, Oslo University Hospital, Oslo, Norway., University of Zurich, Zurich, Switzerland., St Bartholomew's Hospital, London, United Kingdom., University of Pennsylvania, Philadelphia, PA., Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy. Current Affiliation: Englander Institute for Precision Medicine, Weill Cornell Medicine, New York-Presbyterian, NY., Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany., University Department of Medical Oncology, Inselspital, University Hospital, University of Bern, Bern, Switzerland.