Tumor markers in patients with non-seminomatous germ cell tumors of the testis

In 82 patients with non-seminomatous germ cell tumors, the levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) were determined to find if there was a relation to clinical stage. Only two out of 34 patients could be restaged as a result of the presence of elevated marker levels. Markers were present in 12% of patients with stage IIA, 67% with stage IIB amd 85% with stage III. In contrast to HCG, the initial levels of LDH and AFP were related to tumor stage. A return of marker levels to normal during chemotherapy always meant tumor regression and incidated complete remission in 42% of patients. Initial marker levels did not correlate with the eventual destruction of all tumor by chemotherapy. A rise in marker levels always correlated with tumor progression. In conclusion, tumor markers have only a limited value in clinical staging. Disappearance of markers during chemotherapy does not always indicate destruction of all viable tumor, probably because non-producing cell lines such as mature teratoma may persist after chemotherapy.