{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T20:28:31Z","timestamp":1783628911467,"version":"3.55.0"},"reference-count":21,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"7","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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\u2013Meier method, with multivariate analyses identifying prognostic factors. A risk factor model and nomogram were developed and compared with the existing classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Five-year relapse-free survival (RFS) was 77.0% and 45.6%, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .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 &gt;10\u00d7 upper limit of normal was significant for RFS while alpha-fetoprotein &gt;10,000 ng\/mL was significant for OS. The risk factor model stratified patients (0, 1, 2, \u22653 factors) with 5-year OS of 90.3%, 69.6%, 53.8%, and 27.1%, respectively, outperforming existing classification (c-index: 0.668\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      0.629 for OS; 0.666\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      0.619 for RFS). A validated nomogram further enhanced prognostic precision.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This largest single-center Indian cohort of intermediate-risk and poor-risk NSGCTs identifies a \u201cpoorest risk\u201d subset who may benefit from treatment intensification and novel strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-25-00695","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T19:59:11Z","timestamp":1783627151000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Reclassification and Survival Outcomes in Intermediate-Risk and Poor-Risk Nonseminomatous Germ Cell Tumors: Single-Institution Experience From Western India"],"prefix":"10.1200","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7015-3799","authenticated-orcid":true,"given":"Kunal","family":"Jobanputra","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1910-5841","authenticated-orcid":true,"given":"Aditya","family":"Dhanawat","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1722-4337","authenticated-orcid":true,"given":"Gagan","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, 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