A 25-year-old man with a left testicular mass undergoes orchidectomy. Histology shows 80% embryonal carcinoma and 20% teratoma. AFP is 2500 ng/mL and beta-HCG is 50 IU/L. CT chest shows 5 lymph nodes in the retroperitoneum, the largest being 3 cm (no visceral metastases). According to IGCCCG classification, what is the prognostic group?
- A Good prognosis (5-year OS >90%)
- B Poor prognosis (5-year OS ~50%)
- C Intermediate prognosis (5-year OS ~75%) ✓
- D Cannot classify without LDH value
Explanation
The IGCCCG (International Germ Cell Cancer Collaborative Group) classification for non-seminomatous GCT: Good prognosis requires testicular/retroperitoneal primary + no non-pulmonary visceral metastases + AFP <1000, HCG <5000, LDH <1.5×ULN. Intermediate prognosis: testicular/retroperitoneal primary + no non-pulmonary visceral metastases + AFP 1000–10,000 OR HCG 5000–50,000 OR LDH 1.5–10×ULN. Here AFP=2500 (intermediate range: 1000–10,000) with retroperitoneal nodes only = intermediate prognosis group (5-year OS ~75%). Poor prognosis would require mediastinal primary or non-pulmonary visceral metastases or AFP >10,000.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.