Intermediate prognosis in metastatic germ cell tumours—outcome and prognostic factors

Research output: Contribution to journalArticle


Background: For metastatic germ cell tumour patients with intermediate prognosis (IPGCT) according to the IGCCCG classification 5-year overall survival (OS) rates of 79% were described, but recent data suggest significant changes. Patients and methods: To compare the outcome of current IPGCT with former patients and to find new prognosticators a retrospective observational study was performed. Eligibility criteria were: age ≥16 years, diagnosed between 1979 and 2014. Primary end-point was the 5-year OS rate. Results: This database includes 707 IPGCT: group 1 was diagnosed 1979–1996 (n = 237), and group 2 1997–2014 (n = 470). Median follow-up was 8.6 years (IQR: 14.4). Group 1 and 2 received first-line treatment with BEP (median 4 cycles; range 1–6) in 99% (group 1) and 95% (group 2), respectively. The proportion of first-line chemotherapy responders (CR and marker negative PR) was similar: 94% (group 1) and 96% (group 2), respectively (P = 0.290), but OS was superior in group 2 with a 5-year OS rate of 89% compared with 83% in group 1 (P = 0.035). In refractory disease, high-dose chemotherapy and treatment beyond second line was performed more often in group 2. A lactate dehydrogenase (LDH) cut-off value of 2 ULN (P = 0.002; HR 2.121) and alpha-fetoprotein (AFP) levels of 6200 IU/ml (P = 0.032; HR 2.155) pre-chemotherapy were independent prognosticators for OS in a multivariate analysis. Conclusion: Outcome of IPGCT has improved and is now closer to the good prognosis category. LDH and AFP levels represent potential markers to stratify IPGCT before treatment initiation.


  • Christoph Seidel
  • Gedske Daugaard
  • Alexey Tryakin
  • Andrea Necchi
  • Gabriella Cohn Cedermark
  • Olof Ståhl
  • Marcus Hentrich
  • Margarida Brito
  • Costantine Albany
  • Fadi Taza
  • Arthur Gerl
  • Karin Oechsle
  • Carsten Bokemeyer
External organisations
  • University Medical Center Hamburg-Eppendorf
  • Copenhagen University Hospital
  • Istituto Nazionale dei Tumori
  • Karolinska University Hospital
  • Skåne University Hospital
  • Portuguese Institute Of Oncology
  • Indiana University
  • N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences
  • Karolinska Institutet
  • Red Cross Hospital, Munich
  • Ludwig-Maximilian University of Munich
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology


  • IGCCCG classification, Intermediate prognosis, Outcome, Prognostic factors
Original languageEnglish
Pages (from-to)16-25
Number of pages10
JournalEuropean Journal of Cancer
Publication statusPublished - 2018 May 1
Publication categoryResearch
Externally publishedYes