Current concepts in risk factor assessment for advanced germ cell cancer

Disseminated germ cell tumors (GCT) have come to represent the model for a curable malignancy, as cure rates with cisplatin-based chemotherapy coupled with appropriate surgery are 70% to 80%. For patients with favorable prognostic factors who achieve and maintain a complete response, the outlook is good. However, despite advances in the treatment of this disease, a significant number of patients with metastatic GCT fail to respond either primarily or secondarily. Being able to identify poor-risk patients up front would allow for appropriate selection of candidates for high-risk trials. Several different classification systems were previously developed at several treatment centers in the United States and Europe. These models recognized different clinical variables as prognosticators and had unique functional properties. However, these served as precursors to the International Germ Cell Consensus Classification that was developed to establish a universally accepted standard. The development of this system has allowed for valid comparisons of ongoing and future trials. Furthermore, this system will serve to encourage international collaboration for the study of high-risk GCT.