Monoclonal antibody assay of serum placental alkaline phosphatase in the monitoring of testicular tumours

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One hundred and fifty two patients with seminoma of the testis presenting to a regional centre between 1970 and 1981 have been reviewed. One hundred and forty three of these patients were treated primarily with radiotherapy. The actuarial survival of all 152 patients was 84.4% at 5 years and 83.3% at 10 years. The following factors significantly influenced survival: clinical stage; T-stage of the primary tumour; date of first treatment. Patients treated after 1979 had a better prognosis than patients treated before 1973. A group of patients with an actuarial survival of 100% at 5 years could be identified: they were in clinical stage I after lymphography and had T1 primary tumours. We could find no clear relationship between tumour size, duration of symptoms and clinical stage at presentation. We conclude that radiation therapy still has an important role to play in the management of seminoma of the testis. We recommend prophylactic retroperitoneal irradiation for patients in clinical stage I, primary treatment with radiotherapy for patients in clinical stages IIA and IIB, and primary treatment with chemotherapy for patients in clinical stages IIC, III and IV.

Section: Methodsmentioning

confidence: 99%

The management of testicular seminoma: Edinburgh 1970-1981

Duncan¹,

Munro²

1987

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“…At one time PLAP looked promising (Epenetos et al, 1985) but this initial promise has not been fulfilled (Nielsen et al, 1990). The question then arises: might the combination of PLAP, LD, and P HCG prove more useful in the assessment of seminoma than simple consideration of individual markers?…”

Section: Discussionmentioning

confidence: 99%

“…Increased levels of lactate dehydrogenase (LD) may be found in patients with seminoma but this enzyme cannot be considered specific (Taylor et al, 1986;von Eyben et al, 1988;Fossa & Fossa, 1989). A heat-stable alkaline phosphatase isoenzyme, placental alkaline phosphatase (PLAP), has been suggested as a potential marker for seminoma (Epenetos et al, 1985;De Broe & Pollet, 1988) but we have recently shown that, considered alone, its clinical usefulness is limited (Nielsen et al, 1990). PLAP is elevated in healthy smokers and this further complicates its use as a marker for seminoma.…”

mentioning

confidence: 99%

An assessment of combined tumour markers in patients with seminoma: placental alkaline phosphatase (PLAP), lactate dehydrogenase (LD) and β human chorionic gonadotrophin (β HCG)

Munro

Nielsen²,

Duncan³

et al. 1991

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Summary We have assessed the tumour markers placental alkaline phosphatase (PLAP), lactate dehydrogenase (LD), and human chorionic gonadotrophin (p HCG) using 2,000 serum samples from 286 patients with seminoma. The ROC curves show that no one marker performs adequately for the detection of disease either at initial staging or during follow-up. We used a Markov model heuristically to devise strategies, in which marker results were assessed in combination, which might be useful in clinical practice. We found that the best strategy was to consider a test result abnormal only if either the P HCG was > 6 UL1' or the LD was > 400 U 1-l and the PLAP level was > 60 U 1-. This will detect about 50% of patients with disease and the false-positive rate is 2%. In practical terms this means that PLAP need only be estimated in patients whose HCG is <6 IU 1I and whose LD is >400 U 1-'.

“…We have attempted immunocytology on cervical smears using both H317 and H17-E2 in an indirect immunoperoxidase staining technique; however, no clear differences were noted between normal or abnormal cervix. The high levels of cervical tissue PLAP and PLAP-like AP activities suggest a potential as targets for radioimmunolocalisation of invasive and metastatic disease, as has been performed successfully in ovarian and testicular cancer (Epenetos et al, 1985b;Critchley et al, 1986), or for determining the extent of lymphatic spread by lymphangiography as has been attempted in cervical cancer using the HMFG2 mAb (Epenetos, 1985).…”

Section: Cervical Swabsmentioning

confidence: 99%

Placental-type alkaline phosphatase in cervical neoplasia

Pj¹,

Warne²,

Hutchinson³

et al. 1987

Summary Monoclonal antibodies reactive with placental-type alkaline phosphatase have formed the basis of methods for detection of this oncodevelopmental antigen in patients with pre-invasive and invasive cervical neoplasia, with or without evidence of papilloma virus infection. Disease-related elevations of placental-type alkaline phosphatase were not observed in patients' sera. Solubilised cervical smears or biopsy material, and cervical mucus swabs, often contained substantial amounts of this isoenzyme; however, there was no significant difference between any of the patient and control groups. Thus, serological and smear test assays for placental-type alkaline phosphatase were not useful in differential diagnosis of cervical lesions. However, its presence in most biopsy specimens, often at high levels, indicated possible application for in vivo radioimmunoimaging studies of invasive or metastatic cervical cancer.The incidence of cervical cancer has increased markedly in younger women over the last two decades, in part due to venereal transmission of papilloma virus (HPV) infection (Crawford, 1984 (Syrjanen et al., 1985). Screening for pre-invasive cervical carcinoma involves exhaustive examination of smears, and therefore simple rapid techniques for identifying pre-invasive cervical neoplasia are attractive to seek.Potential markers for neoplastic cellular transformation are the oncodevelopmental antigens, such as placental-type alkaline phosphatase. This isoenzyme is a major glycoprotein of term placental trophoblast membranes, and is also expressed on some tumour cell lines including cervical carcinoma cells (McLaughlin et al., 1982). Two major forms of placental-type alkaline phosphatase have been described, the 'placental' and 'placental-like' alkaline phosphatases (PLAP and PLAP-like AP, respectively). These can be distinguished by relative sensitivity to inhibition by L-leucine (Stigbrand et al., 1982) and differential reactivity with certain monoclonal antibodies (mAbs) (McLaughlin & Johnson, 1984).The development of sensitive and specific solid-phase enzyme capture immunoassays (EIA) utilising either the mAb H317 (reactive solely with PLAP) or the mAb H17-E2 (reactive with both PLAP and PLAP-like AP) has broadened investigations of this isoenzyme group in cancer 1984a, b;Epenetos et al., 1985a;Horwich et al., 1985;Tucker et al., 1985). For example, previous serological assays have been limited by detection of elevated isoenzyme levels in healthy individuals, particularly cigarette smokers (Maslow et al., 1983;Tonik et al., 1983). It is now clear that this smoking-associated enzyme is PLAPlike AP, rather than PLAP, and thus ig unreactive in the H317-based assay (McLaughlin et al., 1984b Twelve patients from the Oxford region with established cancer of the cervix were also studied. These had squamous carcinoma (n = 9), adenocarcinoma (n =2) or mixed squamous and adenocarcinoma (n= 1); three of the carcinomas were Stage IA, five were Stage IB, three were IIA, and one was IIB. Monoclonal antibodies (mAbs...