The Value of Serum Tumor Markers in the Staging and Prognosis of Germ Cell Tumors of the Testis

Abstract

During a 3-year prospective study serum chorionic gonadotropin, alpha-fetoprotein and plasma carcinoembryonic antigen were measured in 111 patients with germ cell tumors of the testis. Either human chorionic gonadotropin or alpha-fetoprotein levels were elevated in 91 per cent of the patients with clinically demonstrable non-seminomatous tumors. Among 24 patients who had recurrent disease 16 (67 per cent) had elevated alpha-fetoprotein or human chorionic gonadotropin at a time when recurrence was clinically undetectable. All patients free of tumor had normal levels of human chorionic gonadotropin or alpha-fetoprotein, there being no falsely positive values. Carcinoembryonic antigen was elevated in 33 per cent of patients with seminoma and in 7 per cent of patients with non-seminomatous tumor but carcinoembyonic antigen levels did not correlate with the course of the disease. Determinations of human chorionic gonadotropin and alpha-fetoprotein before lymphadenectomy decreased the error in clinical staging from 35 to 14 per cent. Distant metastases developed in 67 per cent (8 of 12) of patients with stages I and II non-seminomatous tumor with elevated levels of human chorionic gonadotropin or alpha-fetoprotein prior to lymphadenectomy but in only 4 per cent (1 of 25) of patients when the human chorionic gonadotropin and alpha-fetoprotein prior to lymphadenectomy were normal. The levels of human chorionic gonadotropin and alpha-fetoprotein but not carcinoembryonic antigen indicated the true pathologic stage and the prognosis of these patients more accurately than did the conventional clinical parameters.