PDF(Pubmed)
Abstract：
Metastatic germ cell tumors of the testis (GCTs) are risk-stratified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification system. This risk classification is based on anatomical risk factors as well as tumor marker levels of AFP, HCG, and LDH assessed pre-chemotherapy after orchiectomy treatment. An incorrect classification is possible when pre-orchiectomy marker levels are used, possibly resulting in over- or undertreatment of patients. The aim was to investigate the potential frequency and clinical relevance of incorrect risk stratification using pre-orchiectomy tumor marker levels.
A multicenter registry analysis, including patients with metastasized nonseminomatous GCT (NSGCT), was conducted by investigators of the German Testicular Cancer Study Group (GTCSG). Based on the marker levels at different timepoints, IGCCCG risk groups were calculated. The agreement was tested using Cohen\'s kappa.
A total of 672 of 1910 (35%) patients were diagnosed with metastatic NSGCTs, and 523 (78%) had sufficient data for 224 follow-up data points. By using pre-orchiectomy tumor marker levels, 106 patients (20%) would have been incorrectly classified. Seventy-two patients (14%) were classified into a higher risk category, and 34 patients (7%) were classified into a lower risk category. Cohen\'s kappa was 0.69 (p < 0.001), showing a strong agreement between the use of both marker timepoints. The treatment of misclassified patients would have resulted in an overtreatment of 72 patients or undertreatment of 34 patients.
The use of pre-orchiectomy tumor marker levels may lead to an incorrect risk classification and might subsequently lead to under- or overtreatment of patients.
A multicenter registry analysis, including patients with metastasized nonseminomatous GCT (NSGCT), was conducted by investigators of the German Testicular Cancer Study Group (GTCSG). Based on the marker levels at different timepoints, IGCCCG risk groups were calculated. The agreement was tested using Cohen\'s kappa.
A total of 672 of 1910 (35%) patients were diagnosed with metastatic NSGCTs, and 523 (78%) had sufficient data for 224 follow-up data points. By using pre-orchiectomy tumor marker levels, 106 patients (20%) would have been incorrectly classified. Seventy-two patients (14%) were classified into a higher risk category, and 34 patients (7%) were classified into a lower risk category. Cohen\'s kappa was 0.69 (p < 0.001), showing a strong agreement between the use of both marker timepoints. The treatment of misclassified patients would have resulted in an overtreatment of 72 patients or undertreatment of 34 patients.
The use of pre-orchiectomy tumor marker levels may lead to an incorrect risk classification and might subsequently lead to under- or overtreatment of patients.
摘要：
背景：根据国际生殖细胞癌协作小组（IGCCCG）分类系统，对睾丸转移性生殖细胞肿瘤（GCT）进行风险分层。这种风险分类基于解剖学风险因素以及AFP的肿瘤标志物水平，HCG,和LDH评估睾丸切除术治疗后的化疗前。当使用睾丸切除术前标记水平时，错误的分类是可能的，可能导致患者过度治疗或治疗不足。目的是使用睾丸切除术前肿瘤标志物水平调查错误风险分层的潜在频率和临床相关性。
方法：多中心注册分析，包括转移性非精原细胞瘤GCT（NSGCT）患者，由德国睾丸癌研究小组（GTCSG）的研究人员进行。根据不同时间点的标记水平，计算IGCCCG风险组。该协议使用科恩的kappa进行了测试。
结果：1910例患者中有672例（35％）被诊断为转移性NSGCT，523(78%)对224个随访数据点有足够的数据.通过使用睾丸切除术前肿瘤标志物水平，106名患者（20％）将被错误地分类。72名患者（14%）被归类为高风险类别，34例患者(7%)被归类为低风险类别.科恩的卡帕为0.69(p<0.001)，显示了两个标记时间点的使用之间的强烈一致性。错误分类的患者的治疗将导致72名患者的过度治疗或34名患者的治疗不足。
结论：睾丸切除术前肿瘤标志物水平的使用可能导致风险分类不正确，随后可能导致患者治疗不足或过度。
方法：多中心注册分析，包括转移性非精原细胞瘤GCT（NSGCT）患者，由德国睾丸癌研究小组（GTCSG）的研究人员进行。根据不同时间点的标记水平，计算IGCCCG风险组。该协议使用科恩的kappa进行了测试。
结果：1910例患者中有672例（35％）被诊断为转移性NSGCT，523(78%)对224个随访数据点有足够的数据.通过使用睾丸切除术前肿瘤标志物水平，106名患者（20％）将被错误地分类。72名患者（14%）被归类为高风险类别，34例患者(7%)被归类为低风险类别.科恩的卡帕为0.69(p<0.001)，显示了两个标记时间点的使用之间的强烈一致性。错误分类的患者的治疗将导致72名患者的过度治疗或34名患者的治疗不足。
结论：睾丸切除术前肿瘤标志物水平的使用可能导致风险分类不正确，随后可能导致患者治疗不足或过度。
