Prognostic Significance of a Decline in Serum Human Chorionic Gonadotropin Levels After Initial Chemotherapy for Advanced Germ-Cell Carcinoma

Abstract

Forty consecutive patients with advanced germ cell carcinoma and elevated serum levels of human chorionic gonadotorpin (HCG) were studied to assess the prognostic value of the magnitude of the decline in HCG levels after chemotherapy [cisplatin, vinblastine, bleomycin]. If serum levels failed to become normal after the 1st chemotherapy cycle and if the day-22 HCG level/day-1 level was > 1/200 (0.005), an incomplete response to chemotherapy could be predicted with a sensitivity of 90% and a predictive value of 94%. Conversely, if the day-22 level was within normal limits, or if the day-22 level/day-1 level was < 1/200, a successful response to chemotherapy (defined as a 1-yr disease-free interval following cessation of chemotherapy) could be predicted with a sensitivity of 95% and a predictive value of 91% after 1 chemotherapy cycle. Overall, the long-term response to chemotherapy was correctly predicted in 37 of 40 patients (P < 0.0001, compared with actual patient outcome using the .chi.2 test).