RECOGNIZING ABNORMAL MARKER RESULTS THAT DO NOT REFLECT DISEASE IN PATIENTS WITH GERM CELL TUMORS

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Mar 2000RECOGNIZING ABNORMAL MARKER RESULTS THAT DO NOT REFLECT DISEASE IN PATIENTS WITH GERM CELL TUMORS MICHAEL J. MORRIS, and GEORGE J. BOSL MICHAEL J. MORRISMICHAEL J. MORRIS More articles by this author , and GEORGE J. BOSLGEORGE J. BOSL More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67807-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The judicious use of serum α-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase is key to appropriate management of patients with germ cell tumors. Elevated AFP and/or HCG generally indicate active disease. We describe patients with germ cell tumors who had elevated serum AFP and/or HCG but no active disease, despite careful repeat evaluation. Materials and Methods: Histories of 6 cases of germ cell tumors that remained in remission despite abnormal serum AFP and/or HCG were reviewed. Results: Markers were only modestly elevated, remained constant or spontaneously normalized during repeat measurements, and there was no other clinical or radiographic evidence of disease. Patients were treated conservatively with physical examination, radiological tests and repeat marker assays, with no relapse to date. Conclusions: Stable, low increases in serum AFP and HCG may not represent active disease. Careful repeat evaluation will determine whether the markers increase. If no change is noted after appropriate studies have been reviewed by an experienced practitioner to exclude active disease from diagnosis, then consideration should be given to managing such cases with close surveillance to avoid unnecessary chemotherapy. References 1 : International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol1997; 15: 594. Google Scholar 2 : Multivariate analysis of prognostic variables in patients with metastatic testicular cancer. Cancer Res1983; 43: 3403. Google Scholar 3 : Serum tumor marker half-life during chemotherapy allows early prediction of complete response and survival in nonseminomatous germ cell tumors. Cancer Res1990; 50: 5904. Google Scholar 4 : Does serum tumor marker half-life complement pretreatment risk stratification in metastatic nonseminomatous germ cell tumors?. Clin Cancer Res1996; 2: 1565. Google Scholar 5 : The role of tumour markers in the diagnosis and treatment of testicular germ cell cancers. Br J Urol1997; 79: 247. Google Scholar 6 : Microheterogeneity of human alphafetoprotein. Tumour Biol1988; 9: 3. Google Scholar 7 : Clinical relevance of alphafetoprotein microheterogeneity in alphafetoprotein-secreting tumors. Cancer Detect Prev1994; 18: 447. Google Scholar 8 : Alpha-fetoprotein-concanavalin. A binding as a marker to discriminate between germ cell tumours and liver diseases. Eur J Cancer1995; 31A: 2239. Google Scholar 9 : Falsely positive specific human chorionic gonadotropin assays in patients with testicular tumors: conversion to negative with testosterone administration. J Urol1979; 122: 126. Link, Google Scholar 10 : Pulsatile secretion of human chorionic gonadotropin in normal adults. N Engl J Med1987; 317: 1688. Google Scholar 11 : Commercial radioimmunoassay for beta subunit of human chorionic gonadotropin: falsely positive determinations due to elevated serum luteinizing hormone. Cancer1982; 49: 136. Google Scholar 12 : Gonadal function in men with testicular cancer. Semin Oncol1998; 25: 224. Google Scholar 13 : Gonadal dysfunction in patients treated for metastatic germ-cell tumors. J Clin Oncol1986; 4: 1500. Google Scholar 14 Bayer, Inc. Technicon Immuno 1 System Information. Publication No. DA4–1159J95, 1995 Google Scholar From the Department of Medicine, Division of Solid Tumor Oncology, Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center and Department of Medicine, Weill Medical College of Cornell University, New York, New York© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 163Issue 3March 2000Page: 796-801 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsalpha-fetoproteinschorionic gonadotropin, beta subunit, humantesticular neoplasmstumor markers, biologicalneoplasms, germ cell and embryonalMetricsAuthor Information MICHAEL J. MORRIS More articles by this author GEORGE J. BOSL More articles by this author Expand All Advertisement PDF DownloadLoading ...