Szymendera J J, Zborzil J, Sikorowa L, Leńko J, Kamińska J A, Gadek A
Oncology. 1983;40(1):1-10. doi: 10.1159/000225681.
61 patients with seminoma and 113 with nonseminomatous germ cell tumors of the testis were treated according to the histology, stage of disease, and serum levels of tumor markers (CEA, AFP, hCG, hPL and SP1). 33 were stage I, 63 stage II, and 78 stage III patients. Most patients with seminoma, mature teratoma, immature teratoma, and 'pure type' embryonal carcinoma, as well as the latter three types with seminomatous admixture, had normal serum levels of the markers. Sometimes, slightly elevated levels of hCG suggested the presence of metastases. But, serial measurements of the markers were seldom useful in monitoring therapy. The 5-year tumor-free survival rates were favorable: 100% for stage I and II disease; and 57 or 44% for, respectively, stage III seminoma or the other tumors amounting to 10% of the nonseminomatous group. The role of the five markers was significant in patients with teratoma with malignant transformation, choriocarcinoma, endodermal sinus tumor (EST), and embryonal carcinoma or teratocarcinoma with an admixture of EST or choriocarcinoma or both. Elevation of a marker was a grave prognostic sign. The 5-year survival rates were 100, 16, and 4% for stages I, II and III disease, respectively. An elevated level of one or more of the markers assayed was always useful for monitoring therapy. Decreasing level indicated regression. However, return of an elevated level to normal did not indicate eradication of all tumor and called for diagnosis by imaging modalities. Constantly elevated or increasing marker levels during treatment indicated resistance to therapy. An increasing level from any nadir during remission indicated recurrence. Elevated levels of any of the five markers tested were as important as imaging modalities, and often more sensitive.
61例睾丸精原细胞瘤患者和113例睾丸非精原生殖细胞肿瘤患者根据组织学类型、疾病分期及肿瘤标志物（癌胚抗原、甲胎蛋白、人绒毛膜促性腺激素、人胎盘催乳素和SP1）的血清水平接受治疗。其中33例为Ⅰ期患者，63例为Ⅱ期患者，78例为Ⅲ期患者。大多数精原细胞瘤、成熟畸胎瘤、未成熟畸胎瘤和“纯型”胚胎癌患者，以及后三种类型合并精原细胞瘤成分的患者，其肿瘤标志物血清水平正常。有时，人绒毛膜促性腺激素水平轻度升高提示存在转移。但是，连续检测这些标志物对监测治疗很少有用。5年无瘤生存率良好：Ⅰ期和Ⅱ期疾病患者为100%；Ⅲ期精原细胞瘤患者或其他肿瘤患者（占非精原细胞瘤组的10%）分别为57%或44%。这五种标志物在伴有恶性转化的畸胎瘤、绒毛膜癌、内胚窦瘤（EST）以及合并EST或绒毛膜癌或两者的胚胎癌或畸胎癌患者中作用显著。标志物升高是一个严重的预后征象。Ⅰ期、Ⅱ期和Ⅲ期疾病患者的5年生存率分别为100%、16%和4%。检测的一种或多种标志物水平升高对监测治疗总是有用的。水平下降表明病情缓解。然而，升高的水平恢复正常并不表明所有肿瘤均已根除，需要通过影像学检查进行诊断。治疗期间标志物水平持续升高或上升表明对治疗耐药。缓解期从任何最低点开始升高表明复发。检测的五种标志物中任何一种水平升高与影像学检查同样重要，而且往往更敏感。
