Significance of human chorionic gonadotropin, alpha-fetoprotein, and pregnancy-specific beta-1-glycoprotein in the detection of tumor relapse and partial remission in 126 patients with nonseminomatous testicular germ cell tumors

Abstract

After surgery and initial treatment, 126 patients with nonseminomatous germ cell tumors of the testis were followed by estimation of serum human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), and pregnancy-specific beta-1-glycoprotein (SP-1). The median follow-up time was 39 months (range, 12-69 months). An evaluation was made of the sensitivity, specificity, and predictive value of these markers to detect tumor relapse (TR) and partial remission (PR) rates. Five of the 35 (14%) Stage I patients had a TR, and in 4 the TR was recognized early by increasing serum levels of HCG (four times) and AFP (one time). In Stage II and III disease 17 of the 91 (18%) patients had a TR or PR. In 15 of the 17 patients TR and PR were associated with elevated serum levels of HCG (nine times), AFP (seven times), and SP-1 (five times). Rising levels of HCG and/or AFP preceded a clinical confirmation of TR and PR by 4 to 8 weeks. Serum SP-1 did not add useful information. The combined use of serum HCG and AFP gives a sensitive indicator for TR and PR: 19 of 22 (86%) of such patients were recognized. The specificity (98% and 100%, respectively) and the predictive value of positive tests (87% and 100%, respectively) were high for both HCG and AFP.