Utility of serum tumor markers during surveillance for stage I seminoma

作者：Vesprini Danny; Chung Peter^*; Tolan Shaun; Gospodarowicz Mary; Jewett Michael; O'Malley Martin; Sweet Joan; Moore Malcolm; Panzarella Tony; Sturgeon Jeremy; Sugar Linda; Anson Cartwright Lynn; Warde Padraig

来源：Cancer, 2012, 118(21): 5245-5250.

DOI：10.1002/cncr.27539

• serum tumor markers
• stage I seminoma
• surveillance
• biomarkers
• relapse

BACKGROUND: The serum tumor markers a-fetoprotein (AFP), beta-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. Cancer 2012.