Takizawa Akitoshi, Kishida Takeshi, Miura Takeshi, Hattori Yusuke, Noguchi Kazumi, Kubota Yoshinobu
Department of Urology, Yokohama City University Medical Center, Yokohama, Japan.
J Urol. 2008 Mar;179(3):930-4; discussion 934-5. doi: 10.1016/j.juro.2007.11.008. Epub 2008 Jan 22.
The finding of an unexplainable persistent low level of serum human chorionic gonadotropin in the management of testicular cancer sometimes misleads physicians. To avoid unnecessary treatment we suggest a new classification and algorithm for testicular germ cell tumors to discriminate real human chorionic gonadotropin from false-positive results.
A total of 24 patients who seemed to have no cancer with an increased but low level of serum human chorionic gonadotropin were evaluated. They included 17 patients with testicular germ cell tumors and 7 with no evidence of germ cell tumor. In these cases parallel serum and urine human chorionic gonadotropin were measured with the same assay and serum human chorionic gonadotropin was measured with a different assay. False-positive cases were identified by critical criteria according to the classification of gestational trophoblastic disease.
Of 17 cases of testicular germ cell tumor 12 were classified as false-positive and 5 were classified as true-positive. All of the other 7 cases with no evidence of cancer were classified as phantom cases. Of the 7 patients with phantom human chorionic gonadotropin who had a history of germ cell tumor unnecessary treatments had been performed in 3. After the discrimination was implemented no unnecessary treatments or intensive examinations were performed.
Appropriate management is possible based on a good understanding of the causes of low human chorionic gonadotropin. Our algorithm for classifying low human chorionic gonadotropin may help avoid unnecessary treatment in these patients.
在睾丸癌治疗过程中，发现血清人绒毛膜促性腺激素水平持续处于无法解释的低水平有时会误导医生。为避免不必要的治疗，我们提出一种新的睾丸生殖细胞肿瘤分类及算法，以区分真正的人绒毛膜促性腺激素与假阳性结果。
对24例血清人绒毛膜促性腺激素水平升高但处于低水平且看似无癌症的患者进行评估。其中包括17例睾丸生殖细胞肿瘤患者和7例无生殖细胞肿瘤证据的患者。在这些病例中，使用相同检测方法同时检测血清和尿液中的人绒毛膜促性腺激素，并使用不同检测方法检测血清人绒毛膜促性腺激素。根据妊娠滋养细胞疾病的分类，通过关键标准确定假阳性病例。
17例睾丸生殖细胞肿瘤病例中，12例被分类为假阳性，5例被分类为真阳性。其他7例无癌症证据的病例均被分类为幻影病例。在7例有生殖细胞肿瘤病史的幻影人绒毛膜促性腺激素患者中，3例接受了不必要的治疗。实施鉴别后，未进行不必要的治疗或强化检查。
在充分了解人绒毛膜促性腺激素水平低的原因的基础上，可以进行适当的管理。我们对低人绒毛膜促性腺激素进行分类的算法可能有助于避免对这些患者进行不必要的治疗。
