Pre-orchiectomy tumor marker levels should not be used for International Germ Cell Consensus Classification (IGCCCG) risk group assignment

Abstract

PURPOSE To investigate whether the use of pre-orchiectomy instead of pre-chemotherapy tumor marker (TM) levels has an impact on the International Germ Cell Consensus Classification (IGC-CCG) risk group assignment in patients with metastatic germ cell tumors (GCT). METHODS Demographic and clinical information of all patients treated for primary metastatic testicular non-seminomatous GCT in our tertiary care academic center were extracted from medical charts. IGCCCG risk group assignment was correctly performed with pre-chemotherapy marker levels and additionally with pre-orchiectomy marker levels. Agreement between pre-chemotherapy and pre-orchiectomy risk group assignments was assessed using Cohen's kappa. RESULTS Our cohort consisted of 83 patients. The use of pre-orchiectomy TMs resulted in an IGCCCG risk group upstaging in 12 patients (16%, 8 patients from good to intermediate risk and 4 patients from intermediate to poor risk) and a downstaging in 1 patient (1.2%, from intermediate-to good-risk). The agreement between pre-orchiectomy and pre-chemotherapy IGCCCG risk groups resulted in a Cohen's kappa of 0.888 (p < 0.001). CONCLUSIONS Using pre-orchiectomy TMs can result in incorrect IGCCCG risk group assignment, which in turn can impact on the clinical management and follow-up of patients with metastatic GCT. Thus, adherence to the IGCCCG standard using pre-chemotherapy TMs levels is recommended.

m6A RNA modification and its writer/reader VIRMA/YTHDF3 in testicular germ cell tumors: a role in seminoma phenotype maintenance

“…Staging was performed according to the 8 th edition of the American Joint Committee on Cancer (AJCC) staging manual. Patients presenting with metastases at diagnosis were further properly classified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic system [38, 39]. Follow-up was last updated on November 30, 2017.…”

Detailed Characterization of Immune Cell Infiltrate and Expression of Immune Checkpoint Molecules PD-L1/CTLA-4 and MMR Proteins in Testicular Germ Cell Tumors Disclose Novel Disease Biomarkers

“…Clinical files and all histological data were reviewed according to the most recent 8 th edition of the American Joint Committee on Cancer (AJCC) staging manual [56] and the 2016 World Health Organization (WHO) Classification of Tumours of the Urinary System and Male Genital Organs, respectively [9]. Patients with metastatic disease were further categorized according to the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic system [57,58]. Follow-up was last updated on May 2019.…”

European Association of Urology Guidelines on Testis Cancer: Important Take Home Messages

“…Management of these patients is based on primary tumor histology, tumor marker concentrations before chemotherapy, marker decline during the first cycle of chemotherapy in patients with poor risk, interdisciplinary harmonization of chemotherapy and surgery, and significant experience in the delivery of medical treatment to prevent significant therapy-associated complications such as tumor lysis syndrome, acute respiratory distress syndrome in the presence of extensive pulmonary metastases, and choriocarcinoma syndrome. It must be underlined that pre-orchiectomy tumor markers should not be used for risk classification since this approach results in significant upstaging with unnecessary aggressive therapy and a higher risk of long-term toxicities [17]. All patients with intermediate-and poor-risk metastatic NSGCT will require postchemotherapy RPLND with curative intent so that all residual masses are resected completely independent of size and location because of the significantly higher risk of relapse and cancer-associated mortality [18,19].…”