Redefining the IGCCCG classification in advanced non-seminoma

Gillessen, Silke; Collette, Laurence; Daugaard, Gedske; Wit, Ronald de; Tryakin, Alexey; Albany, Costantine; Ståhl, Olof; Fizazi, Karim; Gietema, Jourik A.; Giorgi, U.F.F. De; Hansen, Aaron Richard; Feldman, Darren R.; Cafferty, Fay; Tandstad, Torgrim; Muro, Xavier García del; Huddart, Robert; Sweeney, Christopher J.; Heng, Daniel Yick Chin; Sauvé, Nicolas; Beyer, Jörg

doi:10.1093/annonc/mdz249.002

Cited by 14 publications

(12 citation statements)

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“…Our findings compare favorably with recent results from an analysis of a large data set collected to redefine the IGCCCG classification (Gillessen et al 2019 ; Beyer et al 2020 ). An international consortium contributed data on 9530 advanced non-seminoma GCC patients treated with cisplatin/etoposide based first line chemotherapy between 1990 and 2013.…”

Section: Discussionsupporting

confidence: 91%

“…An international consortium contributed data on 9530 advanced non-seminoma GCC patients treated with cisplatin/etoposide based first line chemotherapy between 1990 and 2013. The 5-years OS was 96%, 89% and 67% for patients in the good-, intermediate- and poor-risk group, respectively (Gillessen et al 2019 ). Further, based on data from 2302 advanced seminoma patients, 5-years OS rates were reported to be 95% and 87% for good- and intermediate-risk patients, respectively (Beyer et al 2020 ).…”

Section: Discussionmentioning

confidence: 99%

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Improved outcomes in metastatic germ cell cancer: results from a large cohort study

Hentrich

Debole²,

Jurinović

et al. 2020

J Cancer Res Clin Oncol

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Purpose Treatment of metastatic germ cell cancer (GCC) is based on the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification published in 1997. 5-year survival rates were reported to be 91%, 79%, and 48% for patients with good, intermediate and poor prognosis, respectively. However, treatment results may have improved over time due to cumulative experience, improved supportive care and modern-type chemotherapy. Methods Patients with metastatic GCC who received cisplatin-based chemotherapy at two institutions in Munich between 2000 and 2013 were retrospectively studied. Clinical characteristics, treatment and outcomes were analyzed with respect to the IGCCG prognostic classification. Results Of 225 patients (median age 35 years), 72 (32%) had seminoma (S) and 153 (68%) nonseminoma. 175 (78%), 30 (13%) and 20 patients (9%) had good, intermediate and poor prognosis according to the IGCCCG classification. The 2-yearprogression free survival of patients with good, intermediate and poor prognosis was 91%, 83% and 37%, and the 5-yearoverall survival (OS) was 98%, 96%, and 66%, respectively. There was no significant difference in the OS between patients in the good and intermediate prognosis group. Conclusion Compared to data from the original IGCCCG classification system, the outcome of patients with metastatic GCC has considerably improved over time. While the prognosis of intermediate-risk patients is excellent, treatment in the poor-prognosis group remains to be improved.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Improved outcomes in metastatic germ cell cancer: results from a large cohort study

Hentrich

Debole²,

Jurinović

et al. 2020

J Cancer Res Clin Oncol

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“…Highlighting the general improvement of outcomes for GCT, an updated meta-analysis in patients with non-seminoma reported 5-year OSs of 94%, 83%, and 71% in good, intermediate, and poor risk disease, respectively, compared with 91%, 71%, and 48% within the original cohort risk groups. This is reinforced by outcomes presented in the IGCCCG Update Consortium for both non-seminoma (96%, 88%, and 67% for good, intermediate, and poor risk disease, respectively) and seminoma (95% and 87% for good and intermediate risk disease, respectively) [ 1 , 2 , 3 , 4 ]. Our study, which has contributed data to the IGCCCG Update Consortium and is based on metastatic GCT patients treated between 1990 and 2014, demonstrated 5-year OSs of 96%, 93%, and 63%, respectively, highlighting the need to identify better prognostication and treatment particularly in the poor risk group.…”

Section: Discussionmentioning

confidence: 94%

“…This risk-stratified approach utilizing clinical parameters (site of primary tumor, location of metastatic lesions, histological subgroup, and degree of tumor marker elevation) was initially reported to have 5-year survival rates of 91%, 79%, and 48% for good, intermediate, and poor risk groupings, respectively, and is the classification scheme commonly used in patient selection for GCT clinical trials. However, it has been increasingly apparent that even though the original classification included data from over 5000 patients, refinement of IGCCCG may be required for which work has recently been presented [ 2 , 3 ]. Recent studies demonstrate improvement in survival, particularly in the IGCCCG intermediate and poor risk groups [ 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…The basis for the improvement is thought to be related to the centralization of patient care in high-volume centers of excellence, in addition to advances seen in salvage treatments, supportive care, and aggressive surgical management of residual masses [ 8 ]. Thus, the real prognostic significance of the IGCCCG classification is being challenged, and attempts to create improved risk stratification are underway [ 2 , 3 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Metastatic Testicular Cancer

et al. 2020

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We investigated the prognostic utility of pre-chemotherapy neutrophil-to-lymphocyte ratio (NLR) in patients with metastatic germ cell tumors (GCTs) undergoing first-line chemotherapy. We utilized two institutional databases to analyze the pretreatment-derived NLR (dNLR). Predictive accuracy was evaluated using the Cox proportional hazard model adjusted for the international germ cell cancer collaborative group (IGCCCG) risk classification. Discriminatory accuracy was evaluated by determining the area under the receiver operating characteristic curve (AUROC). In total, 569 of 690 patients had available dNLR (IGCCCG: good, 64%; intermediate, 21%; poor, 16%). The 5-year and 10-year overall survivals (OSs) for good, intermediate, and poor risk groups were 96.2%, 92.8%, and 62.7% and 93.9%, 90.3%, and 62.7%, respectively. A dNLR of 2 provided the best discriminatory accuracy with an AUROC of 0.58 (95% CI: 0.52–0.65, p = 0.01) for progression-free survival (PFS), whereas for OS, a dNLR of 3 provided the best discriminatory accuracy with an AUROC of 0.62 (95% CI: 0.53–0.70, p < 0.01). A dNLR > 2 was associated with a hazard ratio (HR) of 1.99 (95% CI: 1.27–3.12, p < 0.01) for PFS, which lost its effect after adjustment for IGCCCG (HR: 1.44, 95% CI: 0.90–2.30, p = 0.13). For OS, a dNLR >3 was associated with an HR of 3.00 (95% CI: 1.79–5.01, p < 0.01), but lost its effect after adjustment for IGCCCG. Systemic inflammation plays a role in metastatic GCT, but its prognostic utility beyond established algorithms is limited. The general prognostic value of NLR can be seen across a number of tumors, although the consistency and magnitude of the effect differ according to cancer type, disease stage, and treatment received. We identified that an elevated NLR was associated with an adverse PFS and OS, but not independent of the IGCCCG risk classification. dNLRs >2 and >3 were associated with an adverse PFS and OS, respectively, in patients with metastatic GCT receiving first-line chemotherapy, but not independent of the IGCCCG risk classification.

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Redefining the IGCCCG classification in advanced non-seminoma

Cited by 14 publications

References 0 publications

Improved outcomes in metastatic germ cell cancer: results from a large cohort study

Improved outcomes in metastatic germ cell cancer: results from a large cohort study

The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Metastatic Testicular Cancer

Aktuelle Therapiekonzepte bei Keimzelltumoren des Mannes

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