The Management of Patients with Clinical Stage I Nonseminomatous Testicular Tumors and Persistently Elevated Serologic Markers

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Abstract
We reviewed our experience with patients who had nonseminomatous germ cell tumors clinically limited to the testis and persistently elevated serum human chorionic gonadotropin (HCG) or alpha-fetoprotein (AFP) levels after orchiectomy. All patients had clinical stage I disease with persistently elevated tumor markers that were not decreasing in accordance with the expected metabolic decay rate at retroperitoneal lymph node dissection. Of 30 patients identified 3 had elevated AFP, 24 had elevated HCG and 3 had elevation of both markers. Of the 6 patients with elevated AFP with or without concurrent HCG elevation 5 (83 percent) had relapse and required chemotherapy, as did 6 of 24 (25 percent) with HCG elevation. Patients with persistently elevated AFP after orchiectomy should be treated initially with chemotherapy. Although the majority of patients with elevated serum HCG were disease-free after surgery alone, a fourth of these patients still had relapse and required chemotherapy.