Bosl et al developed an equation for predicting complete remission and poor risk in patients with testicular and extratesticular germ cell tumors. This can help identify patients who may require more aggressive management. The authors are from Memorial Sloan-Kettering Hospital in New York City.
Parameters:
(1) serum LDH in U/L
(2) serum beta human chorionic gonadotropin (HCG) in ng/mL
(3) points for the number of sites with metastases
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Number of Metastatic Sites
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Points
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elevated serum markers only, no metastatic foci
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0
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1 metastatic site
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1
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>= 2 metastatic sites
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2
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H =
= 8.514 - (1.973 * LOG10((LDH) + 1)) - (0.53 * LOG10((HCG) + 1)) - (1.11 * (points for total number of sites with metastases))
probability of complete remission =
= 1 / (1 + EXP((-1) * H))
Seminomas of any site (testicular and extragonadal) were considered good risk.
Poor risk:
(1) testicular nonseminomatous germ cell tumor with probability of complete remission < 0.5.
(2) extragonadal nonseminomatous germ cell tumor
where:
• The "LOG" is ambiguous for LOG10 or LN. My first thought was LN since the second equation uses EXP, but only LOG10 gives values like those shown in Table 1, page 340.
• I made up a "fair" category for testicular nonseminomatous germ cell tumor with a probability of complete remission from 50-74%.
Limitations:
• The methods for determining serum LDH or beta HCG and the respective reference ranges were not specified. This limits transportability of the findings to other sites.
• The description of the patient characteristics is limited. I have no idea if any women were involved or what the ages of the patients were.
