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Serum Tumour Markers in Testicular Germ Cell Tumours: Frequencies of Elevated Levels and Extents of Marker Elevation Are Significantly Associated with Clinical Parameters and with Response to Treatment. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5030349. [PMID: 31275973 PMCID: PMC6558624 DOI: 10.1155/2019/5030349] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Abstract
Introduction Although serum tumor markers beta human chorionic gonadotropin (bHCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH) are well-established tools for the management of testicular germ cell tumours (GCTs), there are only few data from contemporary cohorts of primary GCT patients regarding these biomarkers. Our aim was to evaluate marker elevations in testicular GCTs and to document their associations with various clinical characteristics. Patients and Methods A total of 422 consecutive patients with GCTs were retrospectively analysed regarding serum levels of bHCG, AFP, and LDH during the course of treatment. Additionally, the following characteristics were recorded: histology, age, laterality, clinical stage (CS), pT-stage, and tumour size. Marker elevations were first tabulated in dichotomized way (elevated: yes/no) in various subgroups and second as continuous measured serum values. Descriptive statistical methods were employed to look for differences among subgroups and for associations of elevations with clinical parameters. Results In all GCT patients, the frequencies of elevated levels of bHCG, AFP, LDH, and bHCG or AFP were 37.9%, 25.6%, 32.9%, and 47.6%; in pure seminomas 28%, 2.8%, 29.1%, and 30.3%; and in nonseminoma 53.0%, 60.1%, 38.7%, and 73.8%. Significant associations were noted with pT-stages >pT1, clinical stages >CS1, tumour size, and younger age. Frequencies of marker elevations dropped significantly after treatment, but LDH levels remained elevated in 30.5%-34.1%. Relapsing patients (n=27) had elevated levels of bHCG, AFP, and LDH in 25.9%, 22.2%, and 29.6%, respectively, thirteen of whom with a changed marker pattern. Conclusions The classical GCT-biomarkers correlate with treatment success. Clinical utility is limited due to proportions of < 50% of patients with elevated levels and the low specificity of LDH. The elevation rates are significantly associated with histology, clinical and pT-stages, tumour size, and younger age. Individual marker patterns may change upon relapse. Clinically, ideal biomarkers are yet to be found.
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Vesprini D, Chung P, Tolan S, Gospodarowicz M, Jewett M, O'Malley M, Sweet J, Moore M, Panzarella T, Sturgeon J, Sugar L, Anson-Cartwright L, Warde P. Utility of serum tumor markers during surveillance for stage I seminoma. Cancer 2012; 118:5245-50. [PMID: 22517478 DOI: 10.1002/cncr.27539] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/13/2012] [Accepted: 02/21/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The serum tumor markers α-fetoprotein (AFP), β-human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) are often measured as part of surveillance protocols in patients with stage I seminoma. In this study, the authors evaluated the utility of routine measurement of these markers in the detection of disease relapse. METHODS Data were gathered from a prospectively maintained database of patients who underwent surveillance for stage I testicular seminoma diagnosed between 1982 and 2005 at Princess Margaret Hospital. Patients were followed on a predefined schedule with physical examination (PE), serum tumor markers, abdominopelvic computed tomography, and chest x-rays. The records of patients who relapsed were examined for details of imaging and serum tumor markers throughout the period of follow-up until the time of relapse. RESULTS Of the 527 patients who were managed by surveillance, 75 patients (14%) relapsed at a median follow-up of 72 months. Of these, 65 patients relapsed within the first 3 years and had routine serum tumor markers measured. In total, 11 patients had abnormal tumor markers at the time of relapse (AFP, 0 patients; HCG, 6 patients; LDH, 4 patients; and HCG and LDH, 1 patient). Only 1 patient had an elevated tumor marker (LDH) before relapse, as defined by an abnormal imaging study (n = 64) or physical examination (n = 1), for which the treatment and outcome were not affected. CONCLUSIONS Serum tumor marker levels did not aid in the early diagnosis of disease relapse in patients with stage I seminoma who were managed with surveillance. The current results indicated that routine measurement of serum tumor markers can be discontinued safely in seminoma surveillance schedules.
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Affiliation(s)
- Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
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Gilligan TD, Seidenfeld J, Basch EM, Einhorn LH, Fancher T, Smith DC, Stephenson AJ, Vaughn DJ, Cosby R, Hayes DF. American Society of Clinical Oncology Clinical Practice Guideline on Uses of Serum Tumor Markers in Adult Males With Germ Cell Tumors. J Clin Oncol 2010; 28:3388-404. [DOI: 10.1200/jco.2009.26.4481] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PurposeTo provide recommendations on appropriate uses for serum markers of germ cell tumors (GCTs).MethodsSearches of MEDLINE and EMBASE identified relevant studies published in English. Primary outcomes included marker accuracy to predict the impact of decisions on outcomes. Secondary outcomes included proportions of patients with elevated markers and statistical tests of elevations as prognostic factors. An expert panel developed consensus guidelines based on data from 82 reports.ResultsNo studies directly compared outcomes of decisions with versus without marker assays. The search identified few prospective studies and no randomized controlled trials; most were retrospective series. Lacking data on primary outcomes, most Panel recommendations are based on secondary outcomes (relapse rates and time to relapse).RecommendationsThe Panel recommended against using markers to screen for GCTs, to decide whether orchiectomy is indicated, or to select treatment for patients with cancer of unknown primary. To stage patients with testicular nonseminomas, the Panel recommended measuring three markers (α-fetoprotein [AFP], human chorionic gonadotropin [hCG], and lactate dehydrogenase [LDH]) before and after orchiectomy and before chemotherapy for those with extragonadal nonseminomas. They also recommended measuring AFP and hCG shortly before retroperitoneal lymph node dissection and at the start of each chemotherapy cycle for nonseminoma, and periodically to monitor for relapse. The Panel recommended measuring postorchiectomy hCG and LDH for patients with seminoma and preorchiectomy elevations. They recommended against using markers to guide or monitor treatment for seminoma or to detect relapse in those treated for stage I. However, they recommended measuring hCG and AFP to monitor for relapse in patients treated for advanced seminoma.
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Affiliation(s)
- Timothy D. Gilligan
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Jerome Seidenfeld
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Ethan M. Basch
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Lawrence H. Einhorn
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Timothy Fancher
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - David C. Smith
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Andrew J. Stephenson
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - David J. Vaughn
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Roxanne Cosby
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
| | - Daniel F. Hayes
- From the Taussig Cancer Institute and the Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan-Kettering Cancer Center, New York, NY; Indiana Cancer Pavilion, Indiana University, Indianapolis, IN; Patient Representative; University of Michigan Medical Center, Ann Arbor, MI; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; and Cancer Care Ontario, McMaster University, Hamilton, Ontario,
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