Prognostic factors in metastatic germ cell tumors

Metastatic germ cell cancer is a very heterogeneous group with respect to prognosis under cisplatinum-based chemotherapy. The main determinants of complete response and survival are not only the extension of the metastases but much more the biology of the underlying tumor which is represented by the location of the metastases (pulmonary versus nonpulmonary visceral metastases (liver, bone, central nervous system) and the level of the marker elevation (AFG, HCG, LDH). Using these parameters patients with seminoma can be in two or three prognostic divided groups, depending on the model used; nonseminomatous germ cell cancer can be divided in three prognostic groups (good, intermediate and poor prognosis) with a 5 year survival of 90%, 70%, and 50%, respectively. The rate of marker decline and AFP- "surge" are not proven to be significant indicators of prognosis after the start of chemotherapy. Also, molecular markers i12p, p53, Rb, DNA-repair-capacity, etc, currently do not contribute to the prognostic models. In conclusion, with the present available prognostic models the patients with seminomatous as well as nonseminomatous cancer can be attributed to different prognostic groups for first-line as well as salvage treatment. This allows to the selection of patients for a risk adapted treatment and for the investigation of less toxic regimen for good prognosis patients and more aggressive protocols for intermediate and in particular poor risk patients.