Misuse of tumor marker levels leads to an insufficient International Germ Cell Consensus Classification (IGCCCG) risk group assignment and impaired treatment.
AFP
IGCCCG
LDH
NSGCT
hCG
metastasis
serum tumor marker
testicular germ cell tumor
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
04
06
2023
received:
31
03
2023
accepted:
22
06
2023
medline:
15
9
2023
pubmed:
1
7
2023
entrez:
1
7
2023
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
Identifiants
pubmed: 37392170
doi: 10.1002/cam4.6304
pmc: PMC10501278
doi:
Substances chimiques
Biomarkers, Tumor
0
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
16829-16836Informations de copyright
© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
J Clin Oncol. 2021 May 10;39(14):1563-1574
pubmed: 33822655
J Cancer Res Clin Oncol. 2019 Mar;145(3):781-785
pubmed: 30637464
Urologe A. 2021 Mar;60(3):337-343
pubmed: 33427889
Med Oncol. 2007;24(2):175-81
pubmed: 17848741
Cancer Med. 2023 Aug;12(16):16829-16836
pubmed: 37392170
Biomed Res Int. 2019 May 28;2019:5030349
pubmed: 31275973
Urologe A. 1998 Nov;37(6):635-47
pubmed: 9887493
Oncol Rep. 2014 Jun;31(6):2477-81
pubmed: 24788853
Urol Oncol. 2022 Aug;40(8):385.e9-385.e17
pubmed: 35659482
J Natl Cancer Inst. 2000 Jul 19;92(14):1165-71
pubmed: 10904090
Ann Oncol. 2013 Apr;24(4):878-88
pubmed: 23152360
Clin Oncol (R Coll Radiol). 1997;9(4):207-9
pubmed: 9315391
Ann Oncol. 2017 Nov 01;28(11):2670-2679
pubmed: 29045502
Clin Genitourin Cancer. 2017 Sep 6;:
pubmed: 28964691
J Clin Oncol. 2014 Dec 1;32(34):3817-23
pubmed: 25267754
J Clin Oncol. 2019 Jun 1;37(16):1412-1423
pubmed: 30875280
Clin Chem Lab Med. 2020 Feb 25;58(3):323-325
pubmed: 31926077
Eur J Cancer. 2014 May;50(7):1284-90
pubmed: 24560488
Expert Opin Drug Saf. 2003 Nov;2(6):587-96
pubmed: 14585067
Urol Oncol. 2019 Nov;37(11):809.e19-809.e25
pubmed: 31494007
Eur Urol. 2001 Aug;40(2):102-10
pubmed: 11528185
Biometrics. 1977 Mar;33(1):159-74
pubmed: 843571