The biological and clinical significance of HCG-containing cells in seminoma

Butcher, D. N.; Gregory, Walter M.; Gunter, Pat; Masters, J. R. W.; Parkinson, M. C.

doi:10.1038/bjc.1985.68

Cited by 59 publications

(21 citation statements)

References 19 publications

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“…Some investigators have observed the same good results as for HCG-negative seminomas [10, 14, 16, 18, 19, 26, 27, 28], while others stated a poorer outcome [6, 7, 17, 29, 30, 31, 32]. Nearly all reports were based on small, retrospectively documented series.…”

Section: Discussionmentioning

confidence: 92%

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Prognostic Factors in Seminomas with Special Respect to HCG: Results of a Prospective Multicenter Study

et al. 1999

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Objective: In a prospective multicenter trial, it was our intention to elucidate clinical prognostic factors of seminomas with special reference to the importance of human chorionic gonadotropin (HCG) elevations in histologically pure seminomas. Methods: Together with 96 participating urological departments in Germany, Austria, and Switzerland, we recruited 803 seminoma patients between 1986 and 1991. Out of 726 evaluable cases, 378 had elevated, while 348 had normal HCG values in the cubital vein. Histology was reviewed by two reference pathologists. HCG levels were determined in local laboratories and in a study laboratory. Standard therapy was defined as radiotherapy in stages I (30 Gy) and IIA/B (36 Gy) to the paraaortal and the ispilateral (stage I) and bilateral (stage IIA/B) iliac lymph nodes; higher stages received polychemotherapy and surgery in case of residual tumor masses. Statistics included chi-square tests, linear Cox regression, and log-rank test. Results: The HCG elevation is associated with a larger tumor mass (primary tumor and/or metastases). HCG-positive and HCG-negative seminomas had no different prognostic outcome after standard therapy. The overall relapse rate 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 dehydrogenase concentration and its prolonged marker decay as independent prognostic 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. Conclusions: We conclude that HCG-positive seminomas do not represent a special entity. Provided standard therapy is applied, HCG has no influence on the prognosis. Patients with stage IIB disease should be treated with chemotherapy because of the demonstrated higher relapse rate outside the retroperitoneum.

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Section: Discussionmentioning

confidence: 92%

“…The supposed poor prognosis of HCG-positive seminomas was supported [6, 7, 8, 9]or refuted [10, 11, 12, 13, 14, 15, 16, 17, 18, 19]by reports on small series. It was discussed, whether it represented an intermediate form between seminomas and nonseminomas [20].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Seminomas with Special Respect to HCG: Results of a Prospective Multicenter Study

et al. 1999

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“…Pendant longtemps, on a cru que cette sous-catégorie (sHCG+) avait un pronostic défavorable. À l'examen anatomopathologique, les sHCG+ montrent un aspect cytologique de base semblable aux séminomes non sécrétants (sHCG-), avec en plus la présence soit de cellules géantes syncitiotrophoblastiques, ou des cellules de type Langerhans [71]. Les symptômes locaux des sHCG+ ne sont pas différents de ceux des sHCG-, avec l'apparition d'une masse testiculaire générale-ment indolore.…”

Section: Séminome Sécrétant Des Hcg (Human Chorionic Gonadotropin)unclassified

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Peters

Mirimanoff

2011

Thérapeutique Du Cancer

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“…[2][3][4] We therefore continue regular tumor marker measurement in such patients, which will facilitate future analysis.…”

Section: Reply To Monitoring Of Seminoma Patients With Serum Markersmentioning

confidence: 99%

“…Of 51 patients with nonseminomatous cancers, hCG was elevated in 37 patients (73%) and hCGb in 40 patients (78%) preoperatively, and at relapse, 5 of 18 (28%) patients had an isolated increase in hCGb level. 3 Thanks to rapid improvement of imaging methods, the need for markers in monitoring of seminoma patients has decreased. However, the radiation burden of repeated imaging is not negligible.…”

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confidence: 99%

Reply to monitoring of seminoma patients with serum markers

Vesprini

Warde

Chung

2013

Cancer

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The use of tumor marker determinations for monitoring patients with cancer is common, but this practice is not always evidence-based. Guidelines for monitoring of testicular cancer invariably recommend the use of serum marker determinations, but the recommendations are not based on randomized studies.1 Vesprini et al 2 have evaluated the validity of this practice in a retrospective study based on chart review of serum tumor marker results during surveillance of stage I seminoma. Lactate dehydrogenase (LDH), human chorionic gonadotropin (hCG), and alpha-fetoprotein (AFP) together with clinical and imaging data were registered. Elevated serum markers were found in 11 of 65 (17%) patients at relapse, but in only 1 did the marker elevation precede detection of relapse by imaging or clinical examination. Thus, the authors conclude that routine measurement of serum markers can be discontinued during surveillance of seminoma.In a study on 42 patients with seminoma, we found elevated concentrations of the hCG heterodimer in 17% of the patients preoperatively, but of the free beta-subunit (hCGb) in 52%. It is noteworthy that in 17 cases (40%), hCGb was the only elevated marker. Of 4 patients with seminoma who had a relapse, 2 had an elevated hCGb level; in 1 patient, this was the first sign of relapse. Of 51 patients with nonseminomatous cancers, hCG was elevated in 37 patients (73%) and hCGb in 40 patients (78%) preoperatively, and at relapse, 5 of 18 (28%) patients had an isolated increase in hCGb level. 3Thanks to rapid improvement of imaging methods, the need for markers in monitoring of seminoma patients has decreased. However, the radiation burden of repeated imaging is not negligible. As Vesprini et al suggest, gathering additional data on the utility of serum marker determinations is certainly recommended. The results from our study suggest that serum markers, and especially hCGb, still may have a role in the monitoring of patients with seminoma. These results need to be confirmed in larger studies. CONFLICT OF INTEREST DISCLOSUREThe work was funded by grants from Finska L€ akares€ allskapet (all authors, one grant each) and a grant from the Finnish Cancer Organizations (Ulf-Håkan Stenman

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The biological and clinical significance of HCG-containing cells in seminoma

Cited by 59 publications

References 19 publications

Prognostic Factors in Seminomas with Special Respect to HCG: Results of a Prospective Multicenter Study

Prognostic Factors in Seminomas with Special Respect to HCG: Results of a Prospective Multicenter Study

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Reply to monitoring of seminoma patients with serum markers

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