Abstract
In patients (pts) with metastatic testicular germ cell tumours tumour burden, sites of metastatic disease and the elevation of tumour markers AFP and β -HCG have been identified as prognostic factors. For pts with seminomas (S) no tumour markers are available. In a retrospective analysis we evaluated the possible prognostic role of serum levels for total estrogens (E), estrone and estradiol in pts with non-seminomatous (NS) or seminomatous (S) germ cell tumours. Pts characteristics 481 patients with a median age of 31 years (15–78) treated between 1978–88 were included. Among 155 pts with S 57 (59%) at stage I had elevated E-levels and 5 (22%), 4 (44%) and 2 (25%) pts with minimal (min), moderate (mod) or advanced (adv) disease S, respectively. Among 326 pts with NS 73 pts (60%) at stage I and 34 (39%), 11 (52%)and 32 (54%) pts with min, mod oradv disease had elevated estrogen levels, respectively. Elevated E-levels occurred most frequently with trophoblastic histology (78%) and least frequently with teratocarcinoma (42%). For pts with minimal disease (both S and NS) elevation of serum E-levels >5.5nmol/1 was the only significant prognostic factor for relapse free and overall survival. For adv disease pts elevations of E, AFP and β -HCG were independent prognostic factors for relapse free and overall survival during multivariate analysis. Conclusion Elevated serum E-levels without elevation of AFP or β -HCG occur in 4% (adv)—18% (stage I) of pts with NS and in 9% (adv)—59% (stage I) of pts with S. In addition to AFP and HCG-levels elevation of E-levels seem to constitute an independent prognostic factor for relapse free and overall survival.
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