title: The Second Medical Research Council study of prognostic factors in nonseminomatous germ cell tumors. Medical Research Council Testicular Tumour Working Party.
abstract: OBJECTIVE
  To assess prognostic factors in a large population of patients with metastatic nonseminomatous germ cell tumors (NSGCT) arising in gonadal or extragonadal sites.
  
  
  METHODS
  Data from 795 patients treated with chemotherapy between 1982 and 1986 in 13 centers were analyzed. Particular emphasis was placed on exact tumor measurements (eg, size of nodal masses, number of lung metastases), and the diagnostic pathology was also reviewed. Cox regression analysis was performed on these data. The patients were treated with a variety of cisplatin-containing chemotherapy regimens, 86% of which included etoposide.
  
  
  RESULTS
  With median follow-up of 45 months, overall 3-year survival is 85%. The independently adverse features proved to be (1) the presence of liver, bone, or brain metastases; (2) raised marker levels (alpha-fetoprotein [AFP] level greater than 1,000 kU/L or beta subunit of human chorionic gonadotropin [HCG] greater than 10,000 IU/L [corrected]); (3) the presence of a mediastinal mass greater than 5 cm in diameter; (4) the presence of 20 or more lung metastases; (5) increasing age; and (6) absence of undifferentiated teratoma (embryonal carcinoma) or fibrous tissue from the primary tumor.
  
  
  CONCLUSIONS
  The first four factors were used to define a simple prognostic classification. A good-prognosis group having none of these features comprised 67% of our patient population and had a 3-year survival of 93%. The remaining 33% of patients having at least one of these features had a 3-year survival rate of 68%. These patient groups are currently the subjects of international randomized clinical trials.
authors.affiliation: Medical Research Council, London, England.
authors.forename: G M
authors.initials: GM
authors.lastname: Mead
authors.forename: S P
authors.initials: SP
authors.lastname: Stenning
authors.forename: M C
authors.initials: MC
authors.lastname: Parkinson
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.forename: S D
authors.initials: SD
authors.lastname: Fossa
authors.forename: P M
authors.initials: PM
authors.lastname: Wilkinson
authors.forename: S B
authors.initials: SB
authors.lastname: Kaye
authors.forename: E S
authors.initials: ES
authors.lastname: Newlands
authors.forename: P A
authors.initials: PA
authors.lastname: Cook
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000401:mortality* / Q000473:pathology* / Q000556:secondary; D011379:Prognosis; D016016:Proportional Hazards Models; D012186:Retroperitoneal Neoplasms / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality
chemical_list: D014408:Biomarkers, Tumor