BACKGROUND:The serum tumor markers α-fetoprotein (AFP), β-human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) are often measured as part of surveillance protocols in patients with stage I seminoma.
In this study, the authors evaluated the utility of routine measurement of these markers in the detection of disease relapse.
METHODS:Data were gathered from a prospectively maintained database of patients who underwent surveillance for stage I testicular seminoma diagnosed between 1982 and 2005 at Princess Margaret Hospital. Patients were followed on a predefined schedule with physical examination (PE), serum tumor markers, abdominopelvic computed tomography, and chest x-rays. The records of patients who relapsed were examined for details of imaging and serum tumor markers throughout the period of follow-up until the time of relapse.
RESULTS:Of the 527 patients who were managed by surveillance, 75 patients (14%) relapsed at a median follow-up of 72 months. Of these, 65 patients relapsed within the first 3 years and had routine serum tumor markers measured. In total, 11 patients had abnormal tumor markers at the time of relapse (AFP, 0 patients; HCG, 6 patients; LDH, 4 patients; and HCG and LDH, 1 patient). Only 1 patient had an elevated tumor marker (LDH) before relapse, as defined by an abnormal imaging study (n = 64) or physical examination (n = 1), for which the treatment and outcome were not affected.
CONCLUSIONS: Serum tumor marker levels did not aid in the early diagnosis of disease relapse in patients with stage I seminoma who were managed with surveillance. The current results indicated that routine measurement of serum tumor markers can be discontinued safely in seminoma surveillance schedules.
Written by:
Vesprini D, Chung P, Tolan S, Gospodarowicz M, Jewett M, O'Malley M, Sweet J, Moore M, Panzarella T, Sturgeon J, Sugar L, Anson-Cartwright L, Warde P. Are you the author?
Department of Radiation Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada; Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
Reference: Cancer. 2012 Apr 19. Epub ahead of print.
doi: 10.1002/cncr.27539
PubMed Abstract
PMID: 22517478
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