Risk stratification system for advanced testicular germ cell tumors

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.

Based on the guidelines of the International Germ Cell Cancer collaborative group.

Graphic 61906 Version 12.0

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Risk stratification system for advanced testicular germ cell tumors