Prechemotherapy Not Preorchiectomy Serum Tumor Markers Accurately Identify International Germ Cell Cancer Collaborative Group Prognostic Groups in Nonseminoma

Christian D Fankhauser; Abolghassem Jandari; Laurence Collette; Torgrim Tandstad; Di Maria Jiang; Ugo De Giorgi; Christopher Sweeney; Angelika Terbuch; Michal Chovanec; Robert Huddart; Carsten Bokemeyer; Jörg Beyer; Silke Gillessen

doi:10.1016/j.euros.2023.08.008

Prechemotherapy Not Preorchiectomy Serum Tumor Markers Accurately Identify International Germ Cell Cancer Collaborative Group Prognostic Groups in Nonseminoma

Eur Urol Open Sci. 2023 Sep 9:56:25-28. doi: 10.1016/j.euros.2023.08.008. eCollection 2023 Oct.

Authors

Affiliations

¹ Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland.
² European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
³ The Cancer Clinic, St. Olav's University Hospital and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
⁵ IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy.
⁶ Italian Germ Cell Cancer Group, Genoa, Italy.
⁷ South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia.
⁸ Division of Oncology, Medical University of Graz, Graz, Austria.
⁹ 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia.
¹⁰ Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK.
¹¹ Department of Oncology, Hematology and BMT with Pneumology Section, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹² Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
¹³ Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
¹⁴ University of Southern Switzerland, Lugano, Switzerland.

Abstract

Levels of the serum tumor markers (STMs) α-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase are used in staging classification for metastatic germ-cell cancers and support decisions on the intensity of first-line treatment for patients with nonseminoma. Use of preorchiectomy instead of prechemotherapy STM levels can lead to inadequate classification. We identified 744 men with metastatic gonadal nonseminoma in the International Germ-Cell Cancer Collaborative Group (IGCCCG) Update Consortium database who had preorchiectomy and prechemotherapy STM levels available. Of these, 22% would have had inadequate IGCCCG prognostic group classification if preorchiectomy levels had been used, which would have resulted in overtreatment of 16% and undertreatment of 6% of men. These findings suggest that use of preorchiectomy instead of prechemotherapy STM results may lead to incorrect IGCCCG classification, which could compromise treatment success or expose patients to unnecessary toxicity.

Patient summary: For men with testicular cancer, levels of tumor markers in their blood are used when making decisions on chemotherapy intensity. Use of test results for samples taken before removal of the cancer-bearing testicle instead of immediately before chemotherapy can lead to inadequate treatment recommendations.

Keywords: Germ cell cancer; Prognosis; Treatment outcome; Tumor biomarker.