Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, USA.
J Cancer Res Clin Oncol. 2019 Mar;145(3):781-785. doi: 10.1007/s00432-019-02844-z. Epub 2019 Jan 14.
To investigate whether the use of pre-orchiectomy instead of pre-chemotherapy tumor marker (TM) levels has an impact on the International Germ Cell Consensus Classification (IGCCCG) risk group assignment in patients with metastatic germ cell tumors (GCT).
Demographic and clinical information of all patients treated for primary metastatic testicular non-seminomatous GCT in our tertiary care academic center were extracted from medical charts. IGCCCG risk group assignment was correctly performed with pre-chemotherapy marker levels and additionally with pre-orchiectomy marker levels. Agreement between pre-chemotherapy and pre-orchiectomy risk group assignments was assessed using Cohen's kappa.
Our cohort consisted of 83 patients. The use of pre-orchiectomy TMs resulted in an IGCCCG risk group upstaging in 12 patients (16%, 8 patients from good to intermediate risk and 4 patients from intermediate to poor risk) and a downstaging in 1 patient (1.2%, from intermediate- to good-risk). The agreement between pre-orchiectomy and pre-chemotherapy IGCCCG risk groups resulted in a Cohen's kappa of 0.888 (p < 0.001).
Using pre-orchiectomy TMs can result in incorrect IGCCCG risk group assignment, which in turn can impact on the clinical management and follow-up of patients with metastatic GCT. Thus, adherence to the IGCCCG standard using pre-chemotherapy TMs levels is recommended.
研究在转移性生殖细胞肿瘤（GCT）患者中，使用去势前而非化疗前肿瘤标志物（TM）水平是否会影响国际生殖细胞共识分类（IGCCCG）危险分组。
从病历中提取了在我们的三级护理学术中心接受原发性转移性睾丸非精原细胞瘤 GCT 治疗的所有患者的人口统计学和临床信息。通过化疗前标志物水平和去势前标志物水平正确进行 IGCCCG 危险分组。使用 Cohen's kappa 评估化疗前和去势前危险分组之间的一致性。
我们的队列包括 83 名患者。使用去势前 TM 导致 12 名患者（16%，8 名从低危到中危，4 名从中危到高危）的 IGCCCG 危险组升级，1 名患者（1.2%，从中危到低危）降级。去势前和化疗前 IGCCCG 危险组之间的一致性得出 Cohen's kappa 为 0.888（p<0.001）。
使用去势前 TM 可能导致不正确的 IGCCCG 危险分组，进而影响转移性 GCT 患者的临床管理和随访。因此，建议使用化疗前 TM 水平遵循 IGCCCG 标准。
