Uses of Serum Tumor Markers in Adult Males with Germ Cell Tumors

Published in Journal of Clinical Oncology, Vol 28, Issue 20 (July), 2010: 3388-3404

Timothy D. Gilligan, Jerome Seidenfeld, Ethan M. Basch, Lawrence H. Einhorn, Timothy Fancher, David C. Smith, Andrew J. Stephenson, David J. Vaughn, Roxanne Cosby, and Daniel F. Hayes

Objective

To provide recommendations on appropriate uses for serum markers of germ cell tumors (GCTs).

Methods

Searches of MEDLINE and EMBASE identified relevant studies published in English. Primary outcomes included marker accuracy to predict impact of decisions on outcomes. Secondary outcomes included proportions with elevated markers, and statistical tests of elevations as prognostic factors. An expert panel developed consensus guidelines based on data from 81 reports.

Results

No studies directly compared outcomes of decisions with versus without marker assays. The search identified few prospective studies and no RCTs; most were retrospective series. Lacking data on primary outcomes, most Panel recommendations are based on secondary outcomes (relapse rates and time to relapse).

Recommendations

The Panel recommended against using markers to screen for GCTs, to decide whether orchiectomy is indicated, or to select treatment for patients with cancer of unknown primary. To stage patients with testicular non-seminomas, the Panel recommended measuring three markers (AFP, hCG, and LDH) before and after orchiectomy, and before chemotherapy for those with extra-gonadal non-seminomas. They also recommended measuring AFP and hCG shortly before retroperitoneal lymph node dissection and at the start of each chemotherapy cycle for non-seminoma, and periodically to monitor for relapse. The Panel recommended measuring post-orchiectomy hCG and LDH for patients with seminoma and pre-orchiectomy elevations. They recommended against using markers to guide or monitor treatment for seminoma or to detect relapse in those treated for stage I. However, they recommended measuring hCG and AFP to monitor for relapse in patients treated for advanced seminoma.

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