Prognostic factors in seminomas with special respect to HCG: Results of a prospective multicenter study

Objective: In a prospective multicenter trial, it was our intention to eluc idate clinical prognostic factors of seminomas with special reference to th e importance of human chorionic gonadotropin (HCG) elevations in histologic ally pure seminomas. Methods: Together with 96 participating urological dep artments in Germany, Austria, and Switzerland, we recruited 803 seminoma pa tients between 1986 and 1991. Out of 726 evaluable cases, 378 had elevated, while 348 had normal HCG values in the cubital vein. Histology was reviewe d by two reference pathologists. HCG levels were determined in local labora tories and in a study laboratory. Standard therapy was defined as radiother apy in stages I (30 Gy) and IIA/B (36 Gy) to the paraaortal and the ispilat eral (stage I) and bilateral (stage IIA/B) iliac lymph nodes; higher stages received polychemotherapy and surgery in case of residual tumor masses. St atistics included chi-square tests, linear Cox regression, and log-rank tes t. Results: The HCG elevation is associated with a larger tumor mass (prima ry tumor and/or metastases). HCG-positive and HCG-negative seminomas had no different prognostic outcome after standard therapy. The overall relapse r ate of 6% and the survival rate of 98% after 36 months (median) indicate an excellent prognosis. The calculation of the relative risk of developing a relapse discovered only stage of the disease and elevation of the lactate d ehydrogenase concentration and its prolonged marker decay as independent pr ognostic factors for seminomas. A more detailed analysis of the prognostic significance of the stage revealed that the high relapse rate in stage IIB seminomas after radiotherapy (24%) is responsible for this result. Conclusi ons: We conclude that HCG-positive seminomas do not represent a special ent ity. Provided standard therapy is applied, HCG has no influence on the prog nosis. Patients with stage IIB disease should be treated with chemotherapy because of the demonstrated higher relapse rate outside the retroperitoneum . Copyright (C) 1999 S. Karger AG. Basel.