睾丸生殖细胞肿瘤的血清肿瘤标志物：标记物升高的频率和程度与临床参数和治疗反应显著 ...

Patients and methods: A total of 422 consecutive patients with GCTs were retrospectively analysed regarding serum levels of bHCG, AFP, and LDH during the course of treatment. Additionally, the following characteristics were recorded: histology, age, laterality, clinical stage (CS), pT-stage, and tumour size. Marker elevations were first tabulated in dichotomized way (elevated: yes/no) in various subgroups and second as continuous measured serum values. Descriptive statistical methods were employed to look for differences among subgroups and for associations of elevations with clinical parameters.

患者和方法：回顾性分析了422名连续GCT患者在治疗过程中的bHCG，AFP和LDH血清水平。 另外，记录了以下特征：组织学，年龄，偏侧性，临床分期（CS），pT分期和肿瘤大小。 首先在各个亚组中以二分法（升高：是/否）将标记物升高制成表格，然后将其作为连续测量的血清值。 描述性统计方法用于寻找亚组之间的差异以及海拔与临床参数的关联。

Results: In all GCT patients, the frequencies of elevated levels of bHCG, AFP, LDH, and bHCG or AFP were 37.9%, 25.6%, 32.9%, and 47.6%; in pure seminomas 28%, 2.8%, 29.1%, and 30.3%; and in nonseminoma 53.0%, 60.1%, 38.7%, and 73.8%. Significant associations were noted with pT-stages >pT1, clinical stages >CS1, tumour size, and younger age. Frequencies of marker elevations dropped significantly after treatment, but LDH levels remained elevated in 30.5%-34.1%. Relapsing patients (n=27) had elevated levels of bHCG, AFP, and LDH in 25.9%, 22.2%, and 29.6%, respectively, thirteen of whom with a changed marker pattern.

结果：在所有GCT患者中，bHCG，AFP，LDH和bHCG或AFP水平升高的频率分别为37.9％，25.6％，32.9％和47.6％； 纯精子症患者分别为28％，2.8％，29.1％和30.3％； 在非精原细胞瘤中，分别为53.0％，60.1％，38.7％和73.8％。 pT分期> pT1，临床分期> CS1，肿瘤大小和年龄较小之间存在显着相关性。 治疗后标志物升高的频率明显下降，但LDH水平仍保持在30.5％-34.1％。 复发患者（n = 27）的bHCG，AFP和LDH水平分别升高了25.9％，22.2％和29.6％，其中十三人的标志物模式发生了改变。

Conclusions: The classical GCT-biomarkers correlate with treatment success. Clinical utility is limited due to proportions of < 50% of patients with elevated levels and the low specificity of LDH. The elevation rates are significantly associated with histology, clinical and pT-stages, tumour size, and younger age. Individual marker patterns may change upon relapse. Clinically, ideal biomarkers are yet to be found.

结论：经典的GCT生物标志物与治疗成功相关。由于LDH升高的患者比例<50%，且LDH的特异性较低，临床应用受到限制。升高率与组织学、临床和pT分期、肿瘤大小和年龄有关。个体标记模式可能在复发时改变。临床上，理想的生物标志物尚未找到。

Figure :(a) Individual serum bHCG levels in controls (red) and seminoma patients (blue) ranked by the extent of elevation (x-fold of ULN). Waterfall plot: horizontal line denotes upper limit of norm (ULN). Logarithmic scale on y-axis. (b) Individual serum bHCG levels in controls (red) and nonseminoma patients (blue). The figure illustrates greatly elevated bHCG levels (>10-fold of ULN) to be rare in seminoma but frequent in nonseminoma.