Intermediate-risk and poor-risk nonseminomatous germ cell tumors (NSGCTs) have inferior survival outcomes compared with earlier stages. This study reports the survival outcomes and proposes a prognostic reclassification to identify the poorest risk subset within these groups.
A retrospective analysis was conducted on consecutive patients 15 years and older with intermediate-risk or poor-risk NSGCTs, as per the International Germ Cell Cancer Collaborative Group classification, treated at a tertiary cancer center in western India from 2015 to 2021. Survival outcomes were analyzed using the Kaplan-Meier method, with multivariate analyses identifying prognostic factors. A risk factor model and nomogram were developed and compared with the existing classification.
A total of 400 patients were included with a median follow-up of 60.2 months; 5-year overall survival (OS) was 84.6% for intermediate-risk and 52.6% for poor-risk patients (P < .001). Five-year relapse-free survival (RFS) was 77.0% and 45.6%, respectively (P < .001). Age 35 years and older; mediastinal primary; and liver, lung, and brain metastases were significant factors for both RFS and OS by multivariate analyses. Additionally, lactate dehydrogenase >10× upper limit of normal was significant for RFS while alpha-fetoprotein >10,000 ng/mL was significant for OS. The risk factor model stratified patients (0, 1, 2, ≥3 factors) with 5-year OS of 90.3%, 69.6%, 53.8%, and 27.1%, respectively, outperforming existing classification (c-index: 0.668 v 0.629 for OS; 0.666 v 0.619 for RFS). A validated nomogram further enhanced prognostic precision.
This largest single-center Indian cohort of intermediate-risk and poor-risk NSGCTs identifies a "poorest risk" subset who may benefit from treatment intensification and novel strategies.
JCO global oncology. 2026 Jul 09 [Epub]
Kunal Jobanputra, Aditya Dhanawat, Gagan Prakash, Amandeep Arora, Sayak Dey, Akash Pawar, Bhagyashri Jadhav, Nandini Menon, Minit Shah, Mahendra Pal, Ganesh Bakshi, Vedang Murthy, Priyamvada Maitre, Palak Popat, Nilesh Sable, Aparna Ringe-Katdare, Archi Agrawal, Santosh Menon, Vanita Noronha, Kumar Prabhash, Amit Joshi
Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India., Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India., Department of Biostatistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India., Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India., Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India., Department of Nuclear Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India., Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India., Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.