Yamazaki H, Kondo N, Imanaka K, Kuroda A, Nakauchi K, Machida T
Department of Urology, Jikei University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1990 Jul;81(7):1010-6. doi: 10.5980/jpnjurol1989.81.1010.
The serum levels of alpha-fetoprotein (AFP) are known to undergo acute changes (paradoxical elevation) after effective chemotherapies for testicular germ cell tumors. In order to understand the clinical significance, the changes of the serum AFP levels after PVB therapy for testicular germ cell tumors were analyzed, and their relationship to the treatment effects was investigated in this retrospective study. Thirty-one patients with testicular germ cell tumors (11 with stage I, 7 with stage II, and 13 with stage III) which had been treated by PVB therapy were evaluated. The measurement of the serum AFP levels was performed by radioimmunoassay on Day 1 (the initiation day of the PVB therapy), thereafter on Day 8 and Day 22. The half-life (t1/2) or doubling time (t2) of the serum AFP were calculated. In patients with stage I disease, the serum AFP levels declined nearly according to its biological half-life between Day 1 and Day 22 after termination of chemotherapy (t1/2 = 6.2 days). In patients with stage II or III disease, the changes of the serum AFP levels were not consistent with the treatment results between Day 1 and Day 8. Namely, complete responders revealed a prolonged decline of the serum AFP levels (t1/2 = 63.0 days), partial responders a transient rise of the serum AFP levels (t2 = 49.5 days) and non-responders a sudden rise of the serum AFP levels (t2 = 9.9 days). On the contrary, the serum AFP levels changed in accordance with the treatment effects between Day 8 and Day 22. Early changes of the serum AFP levels were seen in patients with stage II or III disease between Day 1 and Day 8 after chemotherapy. It was indicated that the measurements of the serum AFP levels during this period were not useful for the evaluation of the treatment effects in these patients. Furthermore, it was suggested that the early changes of the serum AFP levels possibly correlate with the poor response. The mechanism of the early changes of the serum AFP was also discussed.
已知在对睾丸生殖细胞肿瘤进行有效的化疗后，血清甲胎蛋白（AFP）水平会发生急性变化（矛盾性升高）。为了解其临床意义，本项回顾性研究分析了睾丸生殖细胞肿瘤患者接受PVB治疗后血清AFP水平的变化，并研究了这些变化与治疗效果的关系。评估了31例接受PVB治疗的睾丸生殖细胞肿瘤患者（I期11例，II期7例，III期13例）。在第1天（PVB治疗开始日）、之后的第8天和第22天通过放射免疫法测定血清AFP水平。计算血清AFP的半衰期（t1/2）或倍增时间（t2）。I期疾病患者在化疗结束后的第1天至第22天之间，血清AFP水平几乎按照其生物半衰期下降（t1/2 = 6.2天）。II期或III期疾病患者在第1天至第8天之间，血清AFP水平的变化与治疗结果不一致。即，完全缓解者血清AFP水平呈延长下降趋势（t1/2 = 63.0天），部分缓解者血清AFP水平呈短暂上升趋势（t2 = 49.5天），无反应者血清AFP水平呈突然上升趋势（t2 = 9.9天）。相反，在第8天至第22天之间，血清AFP水平的变化与治疗效果一致。II期或III期疾病患者在化疗后的第1天至第8天之间可见血清AFP水平的早期变化。表明在此期间测定血清AFP水平对评估这些患者的治疗效果没有帮助。此外，提示血清AFP水平的早期变化可能与反应不佳相关。还讨论了血清AFP早期变化的机制。
