The International Germ Cell Cancer Collaborative Group (IGCCCG) classifies testicular germ cell tumours into good, intermediate, and poor prognosis based on markers and metastatic sites. Which marker level defines 'poor prognosis' for non-seminomatous GCTs?
- A AFP >10,000 ng/mL or β-hCG >50,000 IU/L or LDH >10× ULN ✓
- B AFP >1000 ng/mL or β-hCG >5000 IU/L or LDH >1.5× ULN
- C AFP >50,000 ng/mL or β-hCG >5000 IU/L
- D Any elevated AFP regardless of level with mediastinal primary
Correct answer: A. AFP >10,000 ng/mL or β-hCG >50,000 IU/L or LDH >10× ULN
Explanation
IGCCCG poor prognosis for NSGCT requires: AFP >10,000 ng/mL, OR β-hCG >50,000 IU/L, OR LDH >10× ULN, OR non-pulmonary visceral metastases (brain, liver, bone), OR mediastinal primary NSGCT. Good prognosis: AFP <1000, β-hCG <5000, LDH <1.5×. Intermediate: values between these thresholds. Seminoma has no poor prognosis category — any non-pulmonary visceral met places it in 'intermediate'.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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