DETECTION OF VITAL GERM-CELL TUMOR-CELLS IN SHORT-TERM CELL-CULTURES OF PRIMARY TUMORS AND OF RETROPERITONEAL METASTASIS - CLINICAL IMPLICATIONS

By establishing short-term cell cultures derived from retroperitoneal metastasis after neoadjuvant chemotherapy, our aim was to improve the diagnosis and prognosis in patients with advanced testicular germ cell tumors. The histological evaluation of surgically removed metastatic tissue by retroperitoneal lymphadenectomy (RLA) is extremely complicat ed after previous chemotherapy, but knowledge of persistence of vital tumor cells in residual lesions is of great prognostic value and thera peutic consequence in patients with testicular germ cell tumors. We th erefore investigated whether vital tumor tissue could be detected in s hortterm cen cultures derived from such metastatic lesions by measurin g the concentration of the tumor markers beta human chorionic gonadotr opin (beta HCG) and alpha-1 fetoprotein (AFP) in cell culture supernat ants. We initially demonstrated the specificity of the determination i n cell cultures of human transitional-cell carcinoma cell lines, human foreskin fibroblasts and normal testicular tissue. In a group of 20 p atients with untreated primary testicular germ cell tumors, detection of beta HCG and AFP was increased about threefold in cell culture supe rnatants in comparison to the serum concentration. Finally, we prepare d primary cell cultures from surgically removed retroperitoneal metast asis of 12 patients with testicular germ cell tumors after chemotherap y. The serum concentrations of beta HCG and AFP of all patients were a t normal values when RLA was performed. However, pathologically increa sed concentrations of beta HCG (3/3) and AFP (2/3) in cell culture sup ernatants were found in 3 of 12 cell cultures. Interestingly, these th ree patients with a pathological increase in beta HCG and AFP as deter mined in the supernatant of the short-term cell cultures had tumor pro gression within a mean follow-up of 3 +/- 1 months (P < 0,01), whereas 9 of 12 patients who had no pathological increase in beta HCG and AFP as determined in the supernatant of the short-term cell culture were in complete remission (CR) after a mean follow-up of 40 +/- 11.6 month s.