Gerl A, Lamerz R, Clemm C, Mann K, Hartenstein R, Wilmanns W
Medizinische Kliniken II and III, Klinikum Grosshadern der Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377 München, Germany.
Clin Cancer Res. 1996 Sep;2(9):1565-70.
The goal of this study was to determine whether the serum tumor marker half-life (MHL) of human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) during initial chemotherapy can complement pretreatment risk stratification in metastatic nonseminomatous germ cell tumors. One hundred forty-seven patients were assessable for MHL during the first two cycles of platinum-based chemotherapy. MHL calculation was based on two consecutive values using Kohn's apparent half-life formula (MHL =ln 1/2/G, where G was the gradient of the marker slope) or on three (or more) values using simple linear regression. MHL was regarded as prolonged if it was more than 3.5 days for HCG or more than 7 days for AFP. The median MHL for HCG was 2.8 days (range, 0.7-16.7) and for AFP was 6.2 days (range, 2. 6-65.4). Thirty-five of 108 patients (32%) had a prolonged MHL for HCG, 41 of 114 (36%) had a prolonged MHL for AFP, and in 59 of 147 patients (40%), either or both MHLs were prolonged. If patients with both MHLs normal were compared against patients with either or both MHLs prolonged, highly significant differences in progression-free survival (P < 0.0001) and overall survival (P = 0.0005) were demonstrated. The test accuracy was 70% for both progression-free and overall survival, and it was slightly greater than the overall predictive value of the Medical Research Council prognostic classification. A combination of Medical Research Council criteria and MHL analysis allowed us to refine prognostic assessment. Because MHL analysis is able to complement pretreatment risk stratification and can support selection of patients for early-dose intensified chemotherapy, it should be included in prospective clinical trials for patients with poor-prognosis disease.
本研究的目的是确定在初始化疗期间人绒毛膜促性腺激素（HCG）和甲胎蛋白（AFP）的血清肿瘤标志物半衰期（MHL）是否能补充转移性非精原细胞瘤性生殖细胞肿瘤的预处理风险分层。147例患者在铂类化疗的前两个周期可评估MHL。MHL计算基于使用Kohn表观半衰期公式（MHL = ln 1/2 / G，其中G是标志物斜率的梯度）的两个连续值，或基于使用简单线性回归的三个（或更多）值。如果HCG的MHL超过3.5天或AFP的MHL超过7天，则认为MHL延长。HCG的中位MHL为2.8天（范围0.7 - 16.7），AFP的中位MHL为6.2天（范围2.6 - 65.4）。108例患者中有35例（32%）HCG 的MHL延长，114例中有41例（36%）AFP的MHL延长，147例患者中有59例（40%）一种或两种MHL延长。将两种MHL均正常的患者与一种或两种MHL延长的患者进行比较，无进展生存期（P < 0.0001）和总生存期（P = 0.0005）存在高度显著差异。无进展生存期和总生存期的检验准确性均为70%，略高于医学研究委员会预后分类的总体预测价值。医学研究委员会标准和MHL分析相结合使我们能够完善预后评估。由于MHL分析能够补充预处理风险分层，并可支持选择患者进行早期剂量强化化疗，因此应将其纳入预后不良疾病患者的前瞻性临床试验。
