Significance of primary tumor size and preorchiectomy serum tumor marker level in predicting pathologic stage at retroperitoneal lymph node dissection in clinical Stage A nonseminomatous germ cell tumors.

Abstract

OBJECTIVES:

To determine whether the size of the primary tumor and degree of preorchiectomy serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) elevation predict for retroperitoneal pathologic findings in patients with clinical Stage A nonseminomatous germ cell tumor undergoing primary retroperitoneal lymph node dissection.

METHODS:

The testicular cancer database was queried to identify patients with clinical Stage A nonseminomatous germ cell tumor with normalization of serum tumor markers after orchiectomy who had undergone retroperitoneal lymph node dissection. A total of 779 patients were identified. The preorchiectomy serum tumor marker level was recorded and categorized into the following subsets: AFP: less than 20 (normal), 20 to 100, 100 to 1000, and more than 1000 ng/dL; and beta-hCG: less than 5.0 (normal), 5 to 100, 100 to 1000, and more than 1000. The association between AFP, beta-hCG, and primary tumor size and retroperitoneal pathologic findings was determined.

RESULTS:

The retroperitoneal pathologic examination revealed metastatic disease in 207 patients (26.6%). The preorchiectomy serum beta-hCG level, as a categorical variable, was not predictive of positive retroperitoneal pathologic findings (P = 0.187). The preorchiectomy serum AFP did predict for positive retroperitoneal pathologic findings, with lower serum AFP levels associated with a greater incidence of retroperitoneal metastasis (P <0.001). The primary tumor size was not predictive of positive retroperitoneal pathologic findings (P = 0.113).

CONCLUSIONS:

Neither the primary tumor size nor the preorchiectomy beta-hCG level was predictive of retroperitoneal metastases. However, a normal preorchiectomy AFP level was associated with a greater incidence of retroperitoneal metastases.

• Authors: Stephen D W Beck, Richard S Foster, Richard Bihrle, John P Donohue
• Journal: Urology (Urology) Vol. 69 Issue 3 Pg. 557-9 (Mar 2007) ISSN: 1527-9995 [Electronic] United States
• PMID: 17382165 (Publication Type: Journal Article)

Chemical References

• Chorionic Gonadotropin, beta Subunit, Human
• alpha-Fetoproteins

Topics

• Chorionic Gonadotropin, beta Subunit, Human (blood)
• Humans
• Lymph Node Excision
• Lymphatic Metastasis (pathology)
• Male
• Neoplasms, Germ Cell and Embryonal (blood, pathology, surgery)
• Orchiectomy
• Predictive Value of Tests
• Retroperitoneal Space
• Testicular Neoplasms (blood, pathology, surgery)
• alpha-Fetoproteins (analysis)