Tumor markers at the time of recurrence in patients with germ cell tumors

BACKGROUND, alpha-feroprotein (AFP), human chorionic gonadotropin (HCG), an d lactate dehydrogenase (LDH) closely follow the course of germ cell tumors (GCTs) and are widely used for diagnosis, prognosis, and follow-up purpose s. The objective of this study was to assess the concordance of tumor marke rs at the time of diagnosis and recurrence. METHODS, The authors reviewed the records of 794 patients with GCTs treated in three Spanish hospitals from 1977-1996 and analyzed the concordance bet ween AFP, HCG, and LDH levels at diagnosis and first and second recurrence. A positive marker was defined as a level of AFP > 10 ng/mL, ACG > 5 IU/L, or LDH > the upper limit of normal. One hundred twenty-five patients were i dentified who developed a first recurrence (123 had marker levels recorded) . The median age was 27 years (range, 14-78 years). Histology was seminoma in 36 patients (29%) and nonseminomatous GCT (NSGCT) in 87 patients (71%). RESULTS. Seventy-nine patients (64%) had elevated tumor markers at diagnosi s and 76 (62%) at first recurrence. An elevated marker was present at first recurrence in 58 of 79 patients (73%) with initially positive markers and in 18 of 44 patients (41%) with initially negative markers. In 84 of 123 pa tients (68%), the same marker pattern (positive or negative) was present at the time of diagnosis and at first recurrence, 78% in seminomas and 64% in NSGCTs. The earliest indicator of recurrence was an elevated marker in pat ients with NSGCTs and a radiologic finding in patients with seminomas. Thir ty patients developed a second recurrence, 27 of whom (90%) had the same ma rker pattern as at first recurrence. CONCLUSIONS. Tumor marker pattern at diagnosis is not a good predictor of t he pattern at recurrence, particularly in patients with NSGCTs. Marker asse ssment should be included in the follow-up schedule regardless of levels at the rime of diagnosis. Early detection of recurrence should not rely only on marker levels, even in patients with elevated levels at presentation. Ca ncer 2000;88:162-8. (C) 2000 American Cancer Society.