INTERNATIONAL GERM-CELL CONSENSUS CLASSIFICATION - A PROGNOSTIC FACTOR-ERASED STAGING SYSTEM FOR METASTATIC GERM-CELL CANCERS

Purpose: Cisplatin-containing chemotherapy has dramatically improved t he outlook for patients with metastatic germ cell tumors (GCT), and ov erall cure rates now exceed 80%. To make appropriate risk-based decisi ons about therapy and to facilitate collaborative trials, a simple pro gnostic factor-based staging classification is required. Materials: Co llaborative groups from 10 countries provided clinical data on patient s with metastatic GCT treated with cisplatin-containing chemotherapy. Multivariate analyses of prognostic factors for progression and surviv al were performed and models were validated on on 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 iden tified: mediastinal primary site; degree of elevation of alpha-fetopro tein (AFP), human chorionic gonadotropin (HCG), and lactic dehydrogena se (LDH); and presence of nonpulmonary visceral metastases (NPVM), suc h as liver, bone, and brain. For seminoma, the predominant adverse fea ture was the presence of NPVM. integration of these factors produced t he following groupings: good prognosis, comprising 60% of GCT with a 9 1% (89% to 93%) 5-year survival rate; intermediate prognosis, comprisi ng 26% of GCT with a 79% (75% to 83%) 5-year survival rate; and poor p rognosis, 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 al l the major clinical trial groups who are presently active worldwide. This should be used in clinical practice and in the design and reporti ng of clinical trials to aid international collaboration and understan ding. (C) 1997 by American Society of Clinical Oncology.