Version July 2025
| Seminomas |
| Good risk |
| All of the following: |
| Any primary site |
| No metastases to organs other than the lungs and/or lymph nodes |
| Normal serum AFP |
| Intermediate risk |
| All of the following: |
| Any primary site |
| Metastases to organs other than the lungs and/or lymph nodes |
| Normal serum AFP |
| Nonseminomatous germ cell tumors |
| Good risk |
| All of the following: |
| Testicular or retroperitoneal primary tumors |
| No metastases to organs other than the lungs and/or lymph nodes |
| Serum AFP <1000 ng/mL, beta-hCG <5000 milli-international units/mL, and LDH <3 times the upper limit of normal*¶ |
| Intermediate risk |
| All of the following: |
| Testicular or retroperitoneal primary tumors |
| No metastases to organs other than the lungs and/or lymph nodes |
| Serum AFP 1000 to 10,000 ng/mL* or |
| Serum beta-hCG 5000 to 50,000 milli-international units/mL* or |
| LDH 3 to 10 times the upper limit of normal*¶ |
| Poor risk |
| Any of the following: |
| Mediastinal primary with or without metastases |
| Metastases to organs other than the lungs and/or lymph nodes |
| Serum AFP >10,000 ng/mL* |
| Serum beta-hCG >50,000 milli-international units/mL* |
| LDH more than 10 times the upper limit of normal* |
AFP: alpha-fetoprotein; beta-hCG: beta-human chorionic gonadotropin; LDH: lactic dehydrogenase.
* Markers used for staging and risk classification are postorchiectomy.
¶ Although published staging and risk-stratification tables list a LDH cutoff of 1.5 times, we use a cutoff of 3 times the upper limit of normal because LDH is not specific to germ cell tumors or malignancy and can be elevated for many different reasons. Many germ cell tumor experts would not intensify a patient's treatment from good risk to intermediate risk if the only adverse prognostic factor were a LDH between 1.5 and 3 times the upper limit of normal.