Urology

Answer 1 Poor risk. Risk assessment for patients with testicular tumors is extremely important and can help predict prognosis. The International Germ Cell Consensus risk designation is based on serum tumor marker levels (S stage) and the presence or absence of nonpulmonary visceral metastases.1,2 For nonseminomatous germ cell tumors, presence of a gonadal or retroperitoneal primary tumor with an AFP less than 1000 ng/mL, ßHCG less than 500 mIU/mL, LDH less than 1.5 times normal, and absence of nonpulmonary visceral metastases is considered good-risk disease. A similar tumor location with an AFP 1000 to 10,000 ng/mL, ßHCG 5000 to 50,000 mIU/mL, LDH 1.5 to 10 times normal, and absence of nonpulmonary visceral metastases is considered intermediate-risk disease. The presence of a mediastinal primary tumor, AFP greater than 10,000 ng/mL, ßHCG greater than 50,000 mIU/mL, and LDH greater than 10 times upper limit of normal with the presence of nonpulmonary visceral metastases is considered poor-risk disease. REFERENCES 1. International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 1997;15:594-603. 2. Bosl GJ, Bajorin DF, Sheinfeld J, et al. Cancer of the testis. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer principles & practice of oncology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2001:1491-518. Click here to return to the questions

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