The management of patients with clinical stage I nonseminomatous testicular tumors and persistently elevated serologic markers.

PURPOSE

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.

MATERIALS AND METHODS

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.

RESULTS

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%) had relapse and required chemotherapy, as did 6 of 24 (25%) with HCG elevation.

CONCLUSIONS

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.