{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T04:11:24Z","timestamp":1775103084621,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"16","license":[{"start":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T00:00:00Z","timestamp":1688169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Metastatic germ cell tumors of the testis (GCTs) are risk\u2010stratified according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification system. This risk classification is based on anatomical risk factors as well as tumor marker levels of AFP, HCG, and LDH assessed pre\u2010chemotherapy after orchiectomy treatment. An incorrect classification is possible when pre\u2010orchiectomy marker levels are used, possibly resulting in over\u2010 or undertreatment of patients. The aim was to investigate the potential frequency and clinical relevance of incorrect risk stratification using pre\u2010orchiectomy tumor marker levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multicenter registry analysis, including patients with metastasized nonseminomatous GCT (NSGCT), was conducted by investigators of the German Testicular Cancer Study Group (GTCSG). Based on the marker levels at different timepoints, IGCCCG risk groups were calculated. The agreement was tested using Cohen's kappa.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 672 of 1910 (35%) patients were diagnosed with metastatic NSGCTs, and 523 (78%) had sufficient data for 224 follow\u2010up data points. By using pre\u2010orchiectomy tumor marker levels, 106 patients (20%) would have been incorrectly classified. Seventy\u2010two patients (14%) were classified into a higher risk category, and 34 patients (7%) were classified into a lower risk category. Cohen's kappa was 0.69 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), showing a strong agreement between the use of both marker timepoints. The treatment of misclassified patients would have resulted in an overtreatment of 72 patients or undertreatment of 34 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The use of pre\u2010orchiectomy tumor marker levels may lead to an incorrect risk classification and might subsequently lead to under\u2010 or overtreatment of patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6304","type":"journal-article","created":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T12:33:35Z","timestamp":1688214815000},"page":"16829-16836","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Misuse of tumor marker levels leads to an insufficient International Germ Cell Consensus Classification (<scp>IGCCCG<\/scp>) risk group assignment and impaired treatment"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3731-2441","authenticated-orcid":false,"given":"Matth\u00e4us","family":"Majewski","sequence":"first","affiliation":[{"name":"Department of Urology Federal Armed Services Hospital Ulm  Ulm Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pia","family":"Paffenholz","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Cologne  Cologne Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Ruf","sequence":"additional","affiliation":[{"name":"Department of Urology Federal Armed Services Hospital Ulm  Ulm Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Che","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Duesseldorf  Duesseldorf Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Seidel","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology University Medical Center Hamburg\u2010Eppendorf, University Hospital of Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8993-7171","authenticated-orcid":false,"given":"Julia","family":"Heinzelbecker","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology University Medical Centre Homburg, Saarland University Hospital of Homburg  Homburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans\u2010Ulrich","family":"Schmelz","sequence":"additional","affiliation":[{"name":"Department of Urology Federal Armed Services Hospital Koblenz  Koblenz Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cord","family":"Matthies","sequence":"additional","affiliation":[{"name":"Department of Urology Federal Armed Services Hospital Hamburg  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Albers","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Duesseldorf  Duesseldorf Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carsten","family":"Bokemeyer","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology University Medical Center Hamburg\u2010Eppendorf, University Hospital of Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Cologne  Cologne Germany"},{"name":"Department of Urology Medical University Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8701-9462","authenticated-orcid":false,"given":"Martin","family":"Pichler","sequence":"additional","affiliation":[{"name":"Division of Oncology Medical University of Graz  Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6033-6364","authenticated-orcid":false,"given":"Tim","family":"Nestler","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Cologne  Cologne Germany"},{"name":"Department of Urology Federal Armed Services Hospital Koblenz  Koblenz Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the GTCSG (German Testicular Cancer Study 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