The International Prognostic Factors Study Group developed a prognostic score for patients with metastatic germ cell tumors that failed first-line, cisplatin-based chemotherapy.
Steps:
(1) Determine an initial score.
(2) Convert the initial score to a regroup score.
(3) Adjust the regroup score for histologic features to give the final score.
(4) Assign the risk group from the final score.
Parameters for the initial score:
(1) primary site
(2) prior response
(3) progression-free interval
(4) serum AFP prior to salvage
(5) serum HCG prior to salvage
(6) metastases to lung, brain or bone (LBB)
|
Parameter |
Finding |
Points |
|
primary site |
mediastinal nonseminoma |
3 |
|
|
other extragonadal germ cell |
1 |
|
|
gonadal germ cell |
0 |
|
prior response |
complete response |
0 |
|
|
partial response with negative markers |
0 |
|
|
partial response with positive markers |
1 |
|
|
stable disease |
1 |
|
|
progressive disease |
2 |
|
progression-free interval |
> 3 months |
0 |
|
|
<= 3 months |
1 |
|
AFP prior to salvage |
normal |
0 |
|
|
<= 1,000 in ng/mL |
1 |
|
|
> 1,000 in ng/mL |
2 |
|
HCG prior to salvage |
<= 1,000 U/L |
0 |
|
|
> 1,000 U/L |
1 |
|
metastases to LBB |
no |
0 |
|
|
yes |
1 |
where:
• The reference ranges and analytical methods for AFP and HCG were not reported.
initial score =
= SUM(points for the first 6 parameters)
|
Initial Score |
Regroup Score |
|
0 |
0 |
|
1 or 2 |
1 |
|
3 or 4 |
2 |
|
5 to 10 |
3 |
final score =
= (regroup score) - (1 point if histology pure seminoma, else 0)
|
Final Score |
Risk Group |
3-Year Overall Survival |
|
-1 |
very low |
77% |
|
0 |
low |
66% |
|
1 |
intermediate |
58% |
|
2 |
high |
27% |
|
3 |
very high |
6% |
Specialty: Hematology Oncology, Surgery, general, Urology
ICD-10: ,
