Christoph Seidel1, Gedske Daugaard2, Tim Nestler3, Alexey Tryakin4, Mikhail Fedyanin4, Christian Fankhauser5, Thomas Hermanns5, Jorge Aparicio6, Julia Heinzelbecker7, Pia Paffenholz8, Axel Heidenreich8, Ugo De Giorgi9, Richard Cathomas10, Anja Lorch11, Anna Fingerhut12, Fabian Gayer13, Felix Bremmer13, Patrizia Giannatempo14, Andrea Necchi14, Gaetano Aurilio15, Chiara Casadei9, Ben Tran16, Klaus-Peter Dieckmann17, Margarida Brito18, Christian Ruf3, Christoph Oing19, Carsten Bokemeyer19. 1. Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: c.seidel@uke.de. 2. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 3. Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany. 4. Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation. 5. Department of Urology, University Hospital Zürich, Zurich, Switzerland. 6. Medical Oncology Department, Hospital La Fe, On behalf of the Spanish Germ Cell Cancer Group, Valencia, Spain. 7. Department of Urology, University Hospital Saarland, Homburg/Saar, Germany. 8. Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Austria. 9. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, On behalf of the Italian Germ Cell Cancer Group (IGG), Meldola, Italy. 10. Department of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland. 11. Department of Oncology and Hematology, University Hospital Zürich, Zurich, Switzerland; Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany. 12. Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany. 13. Department of Pathology, University Clinic Göttingen, Göttingen, Germany. 14. Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy. 15. Medical Division of Urogenital and Head & Neck Cancer, IEO European Institute of Oncology IRCCS, Milan, Italy. 16. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. 17. Department of Urology, Asklepios Klinik Altona, Hodentumorzentrum, Germany. 18. Instituto Português de Oncologia de Lisboa, Lisboa, Portugal. 19. Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: The prognostic role of human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH) serum levels in seminoma patients remains uncertain. This observational study evaluates the prognostic impact of tumour marker levels, and other clinicopathological findings, in hCG-positive seminoma patients. METHODS: Seminoma patients with serum hCG levels above normal at first diagnosis were eligible for recruitment. Statistical analysis, including multivariate regression, was performed to identify risk factors. Primary end-points were overall survival (OS) and recurrence-free survival (RFS). RESULTS: We recruited 1031 hCG-positive patients (stage I: n = 586; stage II + III: n = 427) diagnosed between 1981 and 2018. In metastatic disease, LDH levels ≥3 above upper normal limit (UNL) pre- (n = 109) or post-orchiectomy (n = 73) and patients aged ≥40 years (n = 187) were associated with poor prognosis: 5-year OS rates of 84% (LDH ≥3 UNL pre-orchiectomy) versus 92% (<3 UNL pre-orchiectomy) (hazard ratio [HR]: 3.155, [95% confidence interval {CI}: 1.28-7.75], P = 0.012), 82% (≥3 UNL post-orchiectomy) versus 92% (<3 UNL post-orchiectomy) (HR: 6.877, [95% CI: 1.61-29.34]; P = 0.009) and 86% (≥40 years) versus 91% (<40 years) (HR: 6.870, [95% CI: 1.45-13.37], P = 0.009), respectively. A subset of patients with hCG levels ≥2000 IU/l pre-orchiectomy (n = 17) exhibited a poor prognosis, with 5-year OS rates of 73% (≥2000 IU/l) versus 94% (<2000 IU/l) (HR: 3.936, [95% CI: 1.02-12.61], P = 0.047). CONCLUSIONS: Age and LDH levels are significantly associated with poor prognosis in hCG-positive seminoma patients. A small number of patients, with levels of hCG ≥2000 IU/l, may represent a separate prognostic subgroup associated with impaired survival rates.
BACKGROUND: The prognostic role of human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH) serum levels in seminomapatients remains uncertain. This observational study evaluates the prognostic impact of tumour marker levels, and other clinicopathological findings, in hCG-positive seminomapatients. METHODS:Seminomapatients with serum hCG levels above normal at first diagnosis were eligible for recruitment. Statistical analysis, including multivariate regression, was performed to identify risk factors. Primary end-points were overall survival (OS) and recurrence-free survival (RFS). RESULTS: We recruited 1031 hCG-positive patients (stage I: n = 586; stage II + III: n = 427) diagnosed between 1981 and 2018. In metastatic disease, LDH levels ≥3 above upper normal limit (UNL) pre- (n = 109) or post-orchiectomy (n = 73) and patients aged ≥40 years (n = 187) were associated with poor prognosis: 5-year OS rates of 84% (LDH ≥3 UNL pre-orchiectomy) versus 92% (<3 UNL pre-orchiectomy) (hazard ratio [HR]: 3.155, [95% confidence interval {CI}: 1.28-7.75], P = 0.012), 82% (≥3 UNL post-orchiectomy) versus 92% (<3 UNL post-orchiectomy) (HR: 6.877, [95% CI: 1.61-29.34]; P = 0.009) and 86% (≥40 years) versus 91% (<40 years) (HR: 6.870, [95% CI: 1.45-13.37], P = 0.009), respectively. A subset of patients with hCG levels ≥2000 IU/l pre-orchiectomy (n = 17) exhibited a poor prognosis, with 5-year OS rates of 73% (≥2000 IU/l) versus 94% (<2000 IU/l) (HR: 3.936, [95% CI: 1.02-12.61], P = 0.047). CONCLUSIONS: Age and LDH levels are significantly associated with poor prognosis in hCG-positive seminomapatients. A small number of patients, with levels of hCG ≥2000 IU/l, may represent a separate prognostic subgroup associated with impaired survival rates.
Authors: Christoph Seidel; Gedske Daugaard; Tim Nestler; Alexey Tryakin; Mikhail Fedyanin; Christian Daniel Fankhauser; Thomas Hermanns; Jorge Aparicio; Julia Heinzelbecker; Pia Paffenholz; Axel Heidenreich; Ugo De Giorgi; Richard Cathomas; Anja Lorch; Anna Fingerhut; Fabian Gayer; Felix Bremmer; Patrizia Giannatempo; Andrea Necchi; Daniele Raggi; Gaetano Aurilio; Chiara Casadei; Marcus Hentrich; Ben Tran; Klaus-Peter Dieckmann; Margarido Brito; Christian Ruf; Alessandro Mazzocca; Bruno Vincenzi; Olof Stahl; Carsten Bokemeyer; Christoph Oing Journal: World J Urol Date: 2021-03-08 Impact factor: 4.226