Serial monitoring of serum alpha-fetoprotein and chorionic gonadotropin in males with germ cell tumors.

Abstract

Serum AFP and HCG were determined serially by radioimmunoassay or electroimmunoassay in 18 males with germ cell tumors: 13 patients had nonseminomas and 5 had seminomas. Serum AFP values were obtained prior to treatment in 13 patients. In the nonseminoma group, 10/13 patients had elevated serum AFP and 4 also had elevated serum HCG on initial evaluation. No patient had an elevation of HCG alone. Elevated serum AFP was associated with embryonal cell and yolk sac tumor elements, elevated serum HCG with embryonal cell and choriocarcinoma tumor elements. Neither the presence or absence of serum markers nor the degree of serum marker elevation was associated with tumor stage at preoperative evaluation. Postorchiectomy marker elevation was associated with stage greater than I-A. In the seminoma group, 1/5 cases had an elevated HCG and later also AFP. Serum marker elevation was not related to initial stage or anaplastic histology. Serial measurement of serum markers correlated with clinical disease course over a study period of up to 33 months. In all cases without tumor recurrence after treatment, serum markers fell to and remained normal. In the four patients who developed recurrent disease, serum AFP or HCG became elevated 8 to 29 weeks prior to clinical recurrence. Serum AFP 1/2 life was calculated before and after initial treatment and was within the expected range (4–6 days) in patients with no residual disease and elevated in those with remaining tumors. There was one “false normal.” On serial determination, an increasing 1/2 life calculation preceded both a rise in serum AFP and clinical recurrence. Serial serum AFP and HCG determinations are a sensitive method for following patients with germ cell tumors. Serum AFP 1/2 life calculation may be a useful adjunct to staging germ cell tumors and also appears to be even more sensitive than actual serum AFP value in detecting preclinical progressive disease.