Diagnostic Value of Tumour Marker Regression Models in Stage 1 Marker-Positive Testicular Cancer

May, Matthias; Helke, C.; Nitzke, Thomas; Seehafer, M.; Vogler, H; Hoschke, B.

doi:10.1159/000081594

Cited by 8 publications

(2 citation statements)

References 31 publications

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“…Patienten mit erhöhten Tumormarkern nach Ablatio testis haben damit einen Hinweis auf eine Metastasierung [23,24,25,26]. Dabei ist eine Erhöhung so definiert, dass der Tumormarker nicht kinetikgerecht in den Referenzbereich sinkt.…”

Section: Tumormarkererhöhung Nach Ablatio Testisunclassified

Markersysteme beim Hodentumor

Krege

Albers

Heidenreich

2011

Urologe

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Alpha-fetoprotein (AFP), human choriogonadotropin (hCG) and lactate dehydrogenase (LDH) are established tumour markers of testicular germ cell tumours (TGCT) which are used according to the guidelines for primary diagnosis, staging, monitoring of therapeutic response and follow-up. Placental alkaline phosphatase and neurone-specific enolase play no role at all in the diagnosis and management of TGCT.Metastasized TGCT are classified according to the IGCCCG classification system into tumours with good, intermediate and poor prognosis depending on their serum concentration. The risk classification has a direct impact on therapy and determines the intensity of chemotherapy. In rare cases AFP and hCG might be elevated due to non-testicular reasons which have to be taken into consideration for the differential diagnosis especially if marker concentration and clinical presentation do not match. Response to chemotherapy is monitored with AFP and hCG which are determined the day before initiation of the next treatment cycle. Marker increases during or shortly after discontinuation of chemotherapy indicate a poor prognosis and make the immediate initiation of salvage treatment regimes necessary. Only 40-50% and 30% of relapses in patients under active surveillance for clinical stage I disease and after systemic chemotherapy are associated with marker increases. The remainder will be diagnosed by imaging studies or clinical symptoms. Marker increases have to be validated by imaging studies. However, about 10% of all relapsing patients have marker increases only without any imaging evidence of metastatic disease. Residual masses of any size and location have to be treated by postchemotherapy resection once the marker concentration is normalized or once it has reached a stable plateau. So-called desperation surgery in the presence of rising tumour markers is only indicated if no curative chemotherapy is available, all residual masses are completely resectable and no hCG elevation are observed. For follow-up, AFP, hCG and LDH should be evaluated for advanced TGCT and clinical stage I nonseminomas, whereas clinical stage I seminomas should be monitored without any markers.

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Section: Tumormarkererhöhung Nach Ablatio Testisunclassified

Markersysteme beim Hodentumor

Krege

Albers

Heidenreich

2011

Urologe

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“…Conventional criteria of no evidence of lymph node enlargement could be too generic. Site and size of nodes needs to be examined by expert radiologists in order to give a more accurate definition of normal retroperitoneal scans 3,12 . For normally descended testes, areas of nodal metastasis have been defined by anatomical and surgical studies 13 .…”

Section: Diagnosismentioning

confidence: 99%

IGG* Practice Guidelines on Germ Cell Tumor in Adult Male Patients

Giorgi

Nicolai

Tana

et al. 2008

Tumori

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Germ cell tumors are rare neoplasms that affect young males. Nearly 99% of patients with localized stage I disease and nearly 80% of patients with metastatic disease can be cured. Even patients who relapse following chemotherapy can achieve a long-term survival in approximately 30–40% of cases. The main objective in early stages and in good prognosis patients has changed in recent years, and it has become of major importance to reduce treatment-related morbidity without compromising the excellent long-term survival rate. In poor prognosis patients, there is a correlation between the experience of the treating institution and the long-term clinical outcome of the patients, particularly when the most sophisticated therapies are needed. So far, of utmost importance is the information from updated practice guidelines for the diagnosis and treatment of germ cell tumors. The Italian Germ cell cancer Group (IGG) has developed the following clinical recommendations, which identify the current standards in diagnosis and treatment of germ cell tumors in adult males.

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