Clinical calculator summary
Original 1997 IGCCCG prognostic classification
Clinical calculator summary
Original 1997 IGCCCG prognostic classification
A fail-closed metastatic germ cell tumor classifier using histology, primary site, NPVM, and prechemotherapy AFP, hCG, and LDH; 2021 cohort outcomes are reported separately.
Evidence-based context for fast calculator use
- Purpose:
- Assign the original IGCCCG prognostic category for prognosis and trial stratification without presenting the 2021 individualized NSGCT model.
- Population:
- Adults assessed immediately before first-line cisplatin- and etoposide-based chemotherapy for metastatic seminoma or NSGCT/mixed germ cell tumor.
- Factors:
- Histology, Seminoma AFP confirmation, Primary site, NPVM, Prechemotherapy AFP, Prechemotherapy hCG, Prechemotherapy LDH/ULN ratio
- Reference:
- Original IGCCCG 1997 classifier; 2021 seminoma and NSGCT updated cohorts.
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Original 1997 IGCCCG Prognostic Classification
ng/mL
IU/L or mIU/mL
x ULN
Clinical Context & Background
This calculator implements the original 1997 International Germ Cell Cancer Collaborative Group (IGCCCG) categorical classification. It does not implement the individualized 2021 NSGCT prediction model. The 2021 values shown after classification are cohort-level 5-year progression-free survival (PFS) and overall survival (OS) estimates for patients in the original categories, not individualized predictions.
Use immediately before first-line cisplatin- and etoposide-based chemotherapy in adults with metastatic seminoma or non-seminomatous/mixed germ cell tumor. Enter prechemotherapy AFP, hCG, and LDH measured immediately before treatment; LDH must be entered as the measured value divided by the same assay laboratory upper limit of normal (ULN).
Pure seminoma requires AFP confirmed within the reporting laboratory normal range, or a documented non-tumor explanation for an elevation. Elevated, unavailable, or unconfirmed AFP cannot receive an automatic seminoma IGCCCG group and requires manual review. Nonpulmonary visceral metastases (NPVM) means liver, bone, brain, or another nonpulmonary visceral organ; lung and/or nodal disease alone is not NPVM.
Do not use for stage I surveillance decisions, after prior metastatic chemotherapy, salvage prognostication, pediatric disease, ovarian germ cell tumors, or primary CNS germ cell tumors. The category supports prognosis, trial stratification, and multidisciplinary planning but does not by itself determine a chemotherapy regimen.
Formula Logic
Original 1997 decision tree: histology -> seminoma AFP gate -> primary site/NPVM anatomy precedence -> NSGCT highest marker band. Updated 2021 cohort PFS/OS are matched only after the original category is assigned.Reference Data
| Histology | Original 1997 group | 2021 cohort 5-year PFS | 2021 cohort 5-year OS |
|---|---|---|---|
| NSGCT/mixed | Good prognosis | 90% | 96% |
| NSGCT/mixed | Intermediate prognosis | 78% | 89% |
| NSGCT/mixed | Poor prognosis | 54% | 67% |
| Pure seminoma | Good prognosis | 89% | 95% |
| Pure seminoma | Intermediate prognosis | 79% | 88% |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use in adults with metastatic germ cell tumor immediately before first-line cisplatin- and etoposide-based chemotherapy.
- Use prechemotherapy markers measured immediately before treatment and the same-assay LDH-to-ULN ratio.
- Confirm pure seminoma histology and the AFP gate before assigning a seminoma group.
How To Interpret
- The result is the original 1997 categorical group; the PFS and OS values are updated 2021 cohort estimates, not individualized predictions.
- For NSGCT/mixed tumors, mediastinal primary or NPVM takes poor-prognosis precedence; otherwise the highest AFP, hCG, or LDH band governs.
- For pure seminoma with the AFP gate satisfied, NPVM gives intermediate prognosis and no NPVM gives good prognosis; hCG and LDH do not change the original group.
- LDH above 2.5 x ULN adds a 2021 seminoma adverse-prognostic refinement note but does not reclassify the original group.
What To Do Next
- Reconcile histology, anatomy, imaging, and immediately prechemotherapy markers in specialist multidisciplinary review.
- Investigate elevated or unconfirmed AFP before labeling a tumor pure seminoma.
- Use the group alongside the complete clinical context and current guidelines; do not select a regimen from this category alone.
Limitations
- Not for stage I surveillance, prior metastatic chemotherapy or salvage settings, pediatric disease, ovarian germ cell tumors, or primary CNS germ cell tumors.
- Other or unknown NSGCT primary sites are not classified automatically because the original good/intermediate anatomy rule supports testis or retroperitoneal primaries and the poor rule specifically supports mediastinal primary.
- The 2021 outcomes are retrospective cohort estimates and are not individualized probabilities.
- Does not replace full staging, pathology review, organ-function assessment, toxicity assessment, or individualized treatment planning.
Validated Population
Adults with metastatic seminoma or NSGCT treated with first-line cisplatin- and etoposide-based chemotherapy; markers are assessed immediately before chemotherapy.
Anatomy and marker precedence
An NSGCT testis primary with no NPVM and AFP 1,000 ng/mL is intermediate prognosis. Mediastinal primary or NPVM is poor prognosis regardless of otherwise low markers.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed NSGCT cases passed through visible production controls across Good, Intermediate, and Poor prognosis groups.
- The AFP 1,000 intermediate boundary and mediastinal-primary poor-prognosis precedence rendered with the expected 2021 cohort PFS/OS values.
- The former generic Low/Intermediate/High risk gauge was absent, with no unexpected N/A, stale control, or browser-console error observed.
Case-level evidence is retained in validation/browser-revalidation/igcccg-testicular-cancer-risk-2026-08-03.json.
: Local browser remediation
- Valid IGCCCG results now explicitly suppress the shared generic risk gauge so the source-defined Good, Intermediate, and Poor prognosis groups are not relabeled as Low, Intermediate, or High risk.
- Ten source-backed cases passed through visible local browser controls across 11 submissions, covering marker thresholds, anatomy precedence, seminoma/NSGCT cohorts, the AFP gate, LDH refinement, and reset/repeat behavior.
- The existing calculator-specific audit passed 358/358. Production status remains open until this commit is deployed and the public route is revalidated.
Local case-level remediation evidence is retained in validation/browser-production/igcccg-testicular-cancer-risk.local-remediation.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-ui-console. high: Every valid Good, Intermediate, or Poor prognosis result displays the shared Low Risk / Intermediate / High Risk gauge, relabeling source-defined prognosis groups as generic risk bands. | medium: Production emitted minified React error #418 during route load.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/igcccg-testicular-cancer-risk.json.
: Browser input adapter corrected and reverified
- Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
- No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.
: Full validation test
- Verified the original 1997 categorical rules, all six marker thresholds, anatomy precedence, seminoma invariants, invalid inputs, exact trace, and updated 2021 cohort-row mapping across 358 checks.
: Correction history
- Replaced fail-open defaults and categorical marker inputs with strict fail-closed required inputs.
- Added the pure-seminoma AFP confirmation hard stop and manual-review result.
- Corrected numeric threshold boundaries and separated the original 1997 classifier from 2021 cohort outcome labels.
Included in the current validation report.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Popular Tools
Frequently Asked Questions
Is this the individualized 2021 IGCCCG Update model?
No. It applies the original 1997 categorical classifier. The displayed 2021 PFS and OS values are cohort estimates for the matched original category, not individualized predictions.
What counts as nonpulmonary visceral metastases?
Liver, bone, brain, or another nonpulmonary visceral organ. Lung and/or nodal metastases alone do not count as NPVM.
Can pure seminoma be classified when AFP is elevated or unconfirmed?
Not automatically. AFP must be confirmed normal or have a documented non-tumor explanation; otherwise the result is Invalid Input and requires manual review. Pure seminoma never has a poor-prognosis IGCCCG group.
Evidence-based oncology decision support. Verify with clinical guidelines.