title: Identification of a subgroup with worse prognosis among patients with poor-risk testicular germ cell tumor.
abstract: OBJECTIVE
  To clarify the significance of the International Germ Cell Cancer Collaborative Group classification in the 2000s, especially in intermediate- and poor-prognosis testicular germ cell tumor in Japan.
  
  
  METHODS
  We retrospectively analyzed 117 patients with intermediate- and poor-prognosis testicular non-seminomatous germ cell tumor treated at five university hospitals in Japan between 2000 and 2010. Data collected included age, levels of tumor markers, spread to non-pulmonary visceral metastases, treatment details and survival.
  
  
  RESULTS
  The median follow-up period of all patients was 57 months. A total of 50 patients (43%) were classified as having intermediate prognosis, and 67 patients (57%) as poor prognosis according to the International Germ Cell Cancer Collaborative Group classification. As first-line chemotherapy, 92 patients (79%) received bleomycin, etoposide and cisplatin. Of all patients, 74 patients (63%) received second-line chemotherapy. The most commonly used second-line chemotherapy regimens were a combination of taxanes, ifosfamide and platinum in 49 cases (66%). Overall, 33 patients (28%) received third-line chemotherapy. A total of 88 patients (75%) underwent post-chemotherapy surgery. The 5-year overall survival for intermediate (n = 50) and poor prognosis (n = 67) was 89% and 83% (P = 0.21), respectively. In poor prognosis patients, patients with two or more risk factors (any of high lactic dehydrogenase, alpha-fetoprotein and human chorionic gonadotropin levels, and presence of non-pulmonary visceral metastases) had significantly worse survival than those with only one risk factor (71% and 91%, respectively, P = 0.01).
  
  
  CONCLUSIONS
  The 5-year overall survivals of poor-prognosis testicular non-seminomatous germ cell tumor patients reached 83%. Further stratification of poor-prognosis patients based on a number of risk factors has the potential to further identify those with poorer prognosis.
authors.affiliation: Department of Urology, University of Tsukuba, Tsukuba, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Department of Urology, University of Tsukuba, Tsukuba, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of Urology, Graduate School of Medical Sciences, Hokkaido University, Sapporo, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuchiya
authors.affiliation: Department of Urology, Graduate School of Medical Sciences, Hokkaido University, Sapporo, Japan.
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Urology, Graduate School of Medical Sciences, Hokkaido University, Sapporo, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Masumori
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.affiliation: Department of Urology, Akita University, Akita, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Narita
authors.affiliation: Department of Urology, Akita University, Akita, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Tsuchiya
authors.affiliation: Department of Urology, Akita University, Akita, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
authors.affiliation: Department of Urology, University of Tsukuba, Tsukuba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006063:Chorionic Gonadotropin / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000145:classification* / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D009919:Orchiectomy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D007770:L-Lactate Dehydrogenase
keywords: chemotherapy; germ cell tumor; neoplasm of testis; poor prognosis; prognostic subgroups