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Patients were also classified according to the IGCCCG prognostic classification system for metastatic germ cell cancers based on laboratory measurements and the presence of metastatic disease (16).
The most likely etiology of symptomatic gynecomastia in patients with testicular germ cell tumor is the drastic level of [beta]-hCG, which is also a poor prognostic factor in the IGCCCG classification.
Abbreviations OS: Overall survival AYA: Adolescent and young adult NCCN: National Comprehensive Cancer Network NCI: National Cancer Institute CSS: Cancer-specific survival T-GCT: Testicular germ cell tumor NSGCT: Nonseminomatous germ cell tumor EFS: Event free survival NCDB: National Cancer Database RPLND: Retroperitoneal lymph node dissection SEER: Surveillance, Epidemiology and End Results Program COG: Children's Oncology Group SWOG: Southwest Oncology Group AJCC: American Joint Committee on Cancer TNMS: Tumor, node, metastasis, serum IGCCCG: International Germ Cell Cancer Collaborative Group eGFR: Estimated glomerular filtration rate.
The primary treatment of choice for advanced disease consists of three or four cycles of BEP, depending on the risk classification according to the IGCCCG .
The Kaplan-Meier curves of OS and DFS, stratified by the IGCCCG risk groups, are shown in Fig.
et al, 2010)  Variable\Points -1 0 1 Histology Seminoma Non- seminoma Primary site Gonadal Retroperitoneal 1st line CR/PRm- PRm+/SD therapy response PFI > 3 < 3 months months AFP (relapse) Normal < 1000 ng/ml [beta]-hCG < 1000 > 1000 mIU/ml (relapse) mIU/ml Liver/bone/ No Yes brain Mets Variable\Points 2 3 Histology Primary site Mediastinal 1st line PD therapy response PFI AFP (relapse) > 1000 ng/ml [beta]-hCG (relapse) Liver/bone/ brain Mets AFP, alpha-fetoprotein; [beta]-hCG, beta-chorionic human gonadotropin; CR, complete response; IGCCCG, International Germ Cell Cancer Collaborative Group; PD, progressive disease; PFI, platinum-free interval; PR, partial response; SD, stable disease.
(61-64) With neoadjuvant chemotherapy, good prognostic factors include completeness of resection, less than 10% viable tumor cells, and low-risk grouping as defined by the IGCCCG's Moran and Suster Proposed Clinical Staging System for Mediastinal GCTs.
IGCCCG (1997) International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers.
IGCCCG prognostic stages were as follows: good in 3 patients (21%); intermediate in 6 patients (43%); and poor in 5 patients (36%).
In a retrospective study of 184 patients with gonadal or retroperitoneal primary GCTs (PM-NSGCT patients were excluded) treated with salvage high-dose carboplatin and etoposide at Indiana University (IU), Einhorn and colleagues identified platinum-refractory disease, IGCCCG poor-risk classification at first-line chemotherapy, and receipt of HDCT as third-line or later to be associated with adverse outcome .
The pathological stage of the primary tumour was pT1 with clinical stage T1N0M1aS2 (stage IIIA), and he was classified in the good prognosis group as per International Germ Cell Cancer Collaborative Group (IGCCCG) staging system.
The UICC (Union Internationale Contre le Cancer) TNM classification system should be used for staging purposes (Table 2a).[sup.9] Patients with metastatic disease are classified according to the classification system of the International Germ Cell Cancer Collaborative Group (IGCCCG).[sup.10,11] Using this system, patients are divided into "good," "intermediate" and "poor" prognosis groups (Table 2b).
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