Advertisement

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

  • Christian Daniel Fankhauser
  • Travis A. Gerke
  • Lisa Roth
  • Sophia Sander
  • Nico Christian Grossmann
  • Benedikt Kranzbühler
  • Daniel Eberli
  • Tullio Sulser
  • Joerg BeyerEmail author
  • Thomas Hermanns
Original Article – Clinical Oncology
  • 12 Downloads

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 (IGCCCG) 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.

Keywords

Testicular germ cell tumor Biomarkers, tumor Prognosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was waived by the local ethic committee (STV KEK-ZH 25-2008).

References

  1. Beyer J et al (2013) Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol 24:878–888.  https://doi.org/10.1093/annonc/mds579 CrossRefGoogle Scholar
  2. Chovanec M, Abu Zaid M, Hanna N, El-Kouri N, Einhorn LH, Albany C (2017) Long-term toxicity of cisplatin in germ-cell tumor survivors. Ann oncol 28:2670–2679.  https://doi.org/10.1093/annonc/mdx360 CrossRefGoogle Scholar
  3. Chung P, Daugaard G, Tyldesley S, Atenafu EG, Panzarella T, Kollmannsberger C, Warde P (2015) Evaluation of a prognostic model for risk of relapse in stage I seminoma surveillance. Cancer Med 4:155–160.  https://doi.org/10.1002/cam4.324 CrossRefGoogle Scholar
  4. Daugaard G et al (2014) Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol 32:3817–3823.  https://doi.org/10.1200/jco.2013.53.5831 CrossRefGoogle Scholar
  5. DeSantis CE et al (2014) Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 64:252–271.  https://doi.org/10.3322/caac.21235 CrossRefGoogle Scholar
  6. International-Germ-Cell-Cancer-Collaborative-Group (1997) International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 15:594–603CrossRefGoogle Scholar
  7. Kerns SL et al (2018) Cumulative burden of morbidity among testicular cancer survivors after standard cisplatin-based chemotherapy: a multi-institutional study. J Clin Oncol 36:1505–1512.  https://doi.org/10.1200/JCO.2017.77.0735 CrossRefGoogle Scholar
  8. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174.  https://doi.org/10.2307/2529310 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Christian Daniel Fankhauser
    • 1
  • Travis A. Gerke
    • 2
  • Lisa Roth
    • 1
  • Sophia Sander
    • 1
  • Nico Christian Grossmann
    • 1
  • Benedikt Kranzbühler
    • 1
  • Daniel Eberli
    • 1
  • Tullio Sulser
    • 1
  • Joerg Beyer
    • 3
  • Thomas Hermanns
    • 1
  1. 1.Department of Urology, University HospitalUniversity of ZurichZurichSwitzerland
  2. 2.Department of Cancer EpidemiologyMoffitt Cancer CenterTampaUSA
  3. 3.Department of Medical Oncology, Inselspital, University Hospital BernUniversity of BernBernSwitzerland

Personalised recommendations