Bosl G J, Head M D
Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York.
Int J Biol Markers. 1994;9(1):25-8. doi: 10.1177/172460089400900105.
Approximately 80% of previously untreated men with metastatic germ cell tumors will be cured with cisplatin-based chemotherapy. Serum levels of alpha fetoprotein (AFP) or human chorionic gonadotropin (HCG) or both are increased in most of these patients. Pre-treatment clinical characteristics can be used to distinguish between "good" and "poor" risk patients who are either highly likely or unlikely to achieve a complete remission, respectively. A slow rate of decline of either AFP or HCG or both has been associated with an inferior survival in both good and poor risk patients. In multivariate analysis, the pre-treatment risk status and the post-treatment clearance of markers were independent and equal prognostic variables. Similarly, in patients receiving cisplatin+ifosfamide-based salvage chemotherapy, the rate of decline of HCG was an independent predictor variable in addition to the primary site and pre-treatment HCG levels for both overall and event-free survival. Prolonged half-life clearance of serum tumor markers is an important prognostic variable in both previously untreated as well as previously treated germ cel tumor patients. Treatment strategies can be based on marker clearance and prospective clinical trials are warranted.
大约80%以前未经治疗的转移性生殖细胞肿瘤男性患者可通过以顺铂为基础的化疗治愈。大多数这类患者的血清甲胎蛋白（AFP）或人绒毛膜促性腺激素（HCG）或两者水平都会升高。治疗前的临床特征可用于区分“低危”和“高危”患者，前者分别极有可能或不太可能实现完全缓解。AFP或HCG或两者下降速度缓慢与低危和高危患者的较差生存率相关。在多变量分析中，治疗前风险状态和治疗后标志物清除情况是独立且同等重要的预后变量。同样，在接受以顺铂+异环磷酰胺为基础的挽救性化疗的患者中，除了原发部位和治疗前HCG水平外，HCG下降速度是总生存期和无事件生存期的独立预测变量。血清肿瘤标志物清除的半衰期延长在以前未经治疗以及以前接受过治疗的生殖细胞肿瘤患者中都是重要的预后变量。治疗策略可基于标志物清除情况，有必要开展前瞻性临床试验。
