de Wit R, Collette L, Sylvester R, de Mulder P H, Sleijfer D T, ten Bokkel Huinink W W, Kaye S B, van Oosterom A T, Boven E, Stoter G
Rotterdam Cancer Institute and University Hospital, The Netherlands.
Br J Cancer. 1998 Nov;78(10):1350-5. doi: 10.1038/bjc.1998.683.
It has been recognized that the tumour markers alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) may show a transient elevation after the initiation of chemotherapy in non-seminomatous testicular cancer. We investigated the prognostic importance of these so-called marker surges in a cohort of patients treated with cisplatin combination chemotherapy between 1983 and 1991. A total of 669 patients were studied. Of 352 patients who had an elevated AFP at the start of treatment and for whom we had data at both day 1 and day 8, 101 (29%) had a surge. Of 317 patients for whom we had data for HCG, 80 patients (25%) had a surge. It was found that an AFP surge was a strong adverse prognostic factor for progression [hazard ratio (HR) 2.28, P=0.005]. There was no statistically significant difference in survival (HR 1.65, P=0.13). There was no prognostic significance of a HCG surge, either for progression or for survival. To investigate whether a surge was an independent prognostic factor for progression and survival, multivariate Cox regression models were fitted using the independent prognostic factors for progression and survival and the surge/decline variable. An AFP surge was retained in the final model for progression. A HCG surge was of no prognostic importance for progression or survival. We conclude that an AFP surge has an adverse prognostic significance, independent of pretreatment characteristics.
人们已经认识到，在非精原细胞瘤性睾丸癌化疗开始后，肿瘤标志物甲胎蛋白（AFP）和人绒毛膜促性腺激素（HCG）可能会出现短暂升高。我们在1983年至1991年间接受顺铂联合化疗的一组患者中，研究了这些所谓的标志物激增的预后重要性。共研究了669例患者。在治疗开始时AFP升高且我们在第1天和第8天都有数据的352例患者中，101例（29%）出现了激增。在我们有HCG数据的317例患者中，80例（25%）出现了激增。结果发现，AFP激增是进展的一个强烈不良预后因素[风险比（HR）2.28，P = 0.005]。生存率方面无统计学显著差异（HR 1.65，P = 0.13）。HCG激增对进展或生存均无预后意义。为了研究激增是否是进展和生存的独立预后因素，使用进展和生存的独立预后因素以及激增/下降变量拟合了多变量Cox回归模型。AFP激增保留在最终的进展模型中。HCG激增对进展或生存无预后重要性。我们得出结论，AFP激增具有不良预后意义，独立于治疗前特征。
