Observational studyTesticular cancer

Predicting Outcomes in Men With Metastatic Nonseminomatous Germ Cell Tumors (NSGCT): Results From the IGCCCG Update Consortium

J Clin Oncol · 20219,728 patients (prognostic model in 3,543 patients with complete data)

Gillessen S, Sauvé N, Collette L, Daugaard G, de Wit R, Albany C, et al. J Clin Oncol. 2021. 39:1563-1574

Study type: Observational study
Study name: IGCCCG Update
Design: Retrospective analysis of individual patient data from trials and registries (30 institutions or collaborative groups in Europe, North America and Australia), with development and external validation of a prognostic model
Sample size: 9,728 patients (prognostic model in 3,543 patients with complete data)
Source: J Clin Oncol · 2021

In plain words

This large study showed that men whose non-seminoma testicular cancer had spread are treated much more successfully today than in the past: in the good prognosis group almost all, and in the poor group about 2 in every 3, were alive after 5 years. The researchers also found some new factors, such as age and spread to the lungs, for more precise prediction.

Key results

96% (vs 92% in the original classification)

5-year overall survival, good prognosis

5-year progression-free survival 90% vs 89%

89% (vs 80%)

5-year overall survival, intermediate prognosis

5-year progression-free survival 78% vs 75%

67% (vs 48%)

5-year overall survival, poor prognosis

5-year progression-free survival 54% vs 41%

5-year overall survival 87%

All groups combined

5-year progression-free survival 78%

HR 6.61

Non-pulmonary visceral metastases (updated model)

95% CI 4.62–9.46

HR 2.68

Mediastinal primary tumour (updated model)

95% CI 2.04–3.53

Older age (25% higher risk of progression per decade), lung metastases (62% higher) and LDH above 2.5 × upper limit of normal

New adverse factors

Study population

Men with metastatic non-seminomatous germ cell tumours who received cisplatin-‎ and etoposide-based first-line chemotherapy between 1990 and 2013; both clinical trial and registry data were included.

Endpoints

Primary endpoints: progression-free survival (PFS) and overall survival (OS). A new prognostic model for PFS was also developed and validated in an independent data set.

Safety and side effects

This is a prognostic study and did not assess treatment toxicity.

Clinical significance and place in guidelines

This update provided contemporary survival figures for counselling patients and has been incorporated into the EAU guideline (prognostic classification table). The authors suggest that the original 1997 classification should remain the reference for treatment decisions in daily practice, because trials were designed on that basis; the new model (EORTC online calculator) is used for individual prognosis and for designing de-escalation or intensification trials. Despite the improvement, more than 30% of patients with poor prognosis still die of the disease.

Limitations

The study is retrospective, with data from heterogeneous sources (trials and registries). The prognostic model was built only in patients with complete data, and the most common reason for exclusion was missing LDH. Part of the survival improvement may reflect stage migration, better diagnosis and treatment in specialist centres.

Original article (DOI)PubMed

This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.