Prognostic Reclassification and Survival Outcomes in Intermediate-Risk and Poor-Risk Nonseminomatous Germ Cell Tumors: Single-Institution Experience From Western India.

Abstract

Intermediate-risk and poor-risk nonseminomatous germ cell tumors (NSGCTs) have inferior survival outcomes compared with earlier stages. This study reports the survival outcomes and proposes a prognostic reclassification to identify the poorest risk subset within these groups. A retrospective analysis was conducted on consecutive patients 15 years and older with intermediate-risk or poor-risk NSGCTs, as per the International Germ Cell Cancer Collaborative Group classification, treated at a tertiary cancer center in western India from 2015 to 2021. Survival outcomes were analyzed using the Kaplan-Meier method, with multivariate analyses identifying prognostic factors. A risk factor model and nomogram were developed and compared with the existing classification. A total of 400 patients were included with a median follow-up of 60.2 months; 5-year overall survival (OS) was 84.6% for intermediate-risk and 52.6% for poor-risk patients (<i>P</i> < .001). Five-year relapse-free survival (RFS) was 77.0% and 45.6%, respectively (<i>P</i> < .001). Age 35 years and older; mediastinal primary; and liver, lung, and brain metastases were significant factors for both RFS and OS by multivariate analyses. Additionally, lactate dehydrogenase >10× upper limit of normal was significant for RFS while alpha-fetoprotein >10,000 ng/mL was significant for OS. The risk factor model stratified patients (0, 1, 2, ≥3 factors) with 5-year OS of 90.3%, 69.6%, 53.8%, and 27.1%, respectively, outperforming existing classification (c-index: 0.668 <i>v</i> 0.629 for OS; 0.666 <i>v</i> 0.619 for RFS). A validated nomogram further enhanced prognostic precision. This largest single-center Indian cohort of intermediate-risk and poor-risk NSGCTs identifies a "poorest risk" subset who may benefit from treatment intensification and novel strategies.