scholarly journals Serum Tumour Markers in Testicular Germ Cell Tumours: Frequencies of Elevated Levels and Extents of Marker Elevation Are Significantly Associated with Clinical Parameters and with Response to Treatment

2019 ◽  
Vol 2019 ◽  
pp. 1-22 ◽  
Author(s):  
Klaus-Peter Dieckmann ◽  
Hanna Simonsen-Richter ◽  
Magdalena Kulejewski ◽  
Petra Anheuser ◽  
Henrik Zecha ◽  
...  
Keyword(s):  
Germ Cell ◽  
Tumour Size ◽  
Clinical Stage ◽  
Treatment Success ◽  
Response To Treatment ◽  
Clinical Parameters ◽  
Germ Cell Tumours ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Tumours ◽  
Younger Age

Introduction. Although serum tumor markers beta human chorionic gonadotropin (bHCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH) are well-established tools for the management of testicular germ cell tumours (GCTs), there are only few data from contemporary cohorts of primary GCT patients regarding these biomarkers. Our aim was to evaluate marker elevations in testicular GCTs and to document their associations with various clinical characteristics.Patients and Methods. A total of 422 consecutive patients with GCTs were retrospectively analysed regarding serum levels of bHCG, AFP, and LDH during the course of treatment. Additionally, the following characteristics were recorded: histology, age, laterality, clinical stage (CS), pT-stage, and tumour size. Marker elevations were first tabulated in dichotomized way (elevated: yes/no) in various subgroups and second as continuous measured serum values. Descriptive statistical methods were employed to look for differences among subgroups and for associations of elevations with clinical parameters.Results. In all GCT patients, the frequencies of elevated levels of bHCG, AFP, LDH, and bHCG or AFP were 37.9%, 25.6%, 32.9%, and 47.6%; in pure seminomas 28%, 2.8%, 29.1%, and 30.3%; and in nonseminoma 53.0%, 60.1%, 38.7%, and 73.8%. Significant associations were noted with pT-stages >pT1, clinical stages >CS1, tumour size, and younger age. Frequencies of marker elevations dropped significantly after treatment, but LDH levels remained elevated in 30.5%-34.1%. Relapsing patients (n=27) had elevated levels of bHCG, AFP, and LDH in 25.9%, 22.2%, and 29.6%, respectively, thirteen of whom with a changed marker pattern.Conclusions. The classical GCT-biomarkers correlate with treatment success. Clinical utility is limited due to proportions of < 50% of patients with elevated levels and the low specificity of LDH. The elevation rates are significantly associated with histology, clinical and pT-stages, tumour size, and younger age. Individual marker patterns may change upon relapse. Clinically, ideal biomarkers are yet to be found.

scholarly journals Associations of serum levels of microRNA-371a-3p (M371) with risk factors for progression in nonseminomatous testicular germ cell tumours clinical stage 1

2021 ◽  
Author(s):  
Klaus-Peter Dieckmann ◽  
Cansu Dumlupinar ◽  
Arlo Radtke ◽  
Cord Matthies ◽  
Renate Pichler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Germ Cell ◽  
Tumour Size ◽  
Clinical Stage ◽  
Serum Levels ◽  
Germ Cell Tumours ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Tumours ◽  
Stage 1

Abstract Purpose Lymphovascular invasion (LV1) and presence of > 50% embryonal carcinoma (> 50% EC) represent risk factors for progression in patients with clinical stage 1 (CS1) nonseminomatous (NS) testicular germ cell tumours. As serum levels of microRNA-371a-3p (M371) are capable of detecting small amounts of GCT, we evaluated if LV1 and > 50% EC are associated with M371 levels. Methods M371 serum levels were measured postoperatively in 153 NS CS1 patients and both pre- and postoperatively in 131 patients. We registered the following factors: age, tumour size, LV status, > 50% EC, teratoma in primary, preoperative elevation of classical tumour markers. M371 expression was compared among subgroups. The ability of M371 to predict LV1 was calculated by receiver operating characteristics (ROC) curves. Multiple regression analysis was used to look for associations of M371 levels with other factors. Results Postoperatively elevated M371 levels were found in 29.4% of the patients, but were neither associated with LV status nor with > 50% EC. Likewise, relative decrease of M371 was not associated. ROC analysis of postoperative M371 levels revealed an AUC of 0.5 for the ability to predict LV1 while preoperative M371 had an AUC of 0.732. Multiple regression analysis revealed significant associations of preoperative M371 levels with LV status (p = 0.003), tumour size (p = 0.001), > 50% EC (p = 0.004), and teratoma component (p = 0.045). Conclusion Postoperatively elevated M371 levels are not associated with risk factors for progression in NS CS1 patients. However, the significant association of preoperative M371 expression with LV1 deserves further evaluation.

Testicular cancer

2017 ◽  
Author(s):  
Christian Winter ◽  
Peter Albers
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Clinical Stage ◽  
Primary Tumour ◽  
Genetic Alterations ◽  
Subsequent Treatment ◽  
Germ Cell Tumours ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Tumours ◽  
Solid Malignancy

Testicular germ cell tumours (GCTs) represent the most common solid malignancy of young men aged 15–40 years. The disease is rising in incidence. Germ cell tumours are best divided into those with pure seminoma and non-seminoma (NSGCT) histology. While cryptorchidism is clearly established as a risk factor, the pathogenesis of testicular cancer remains unknown. Familial studies and molecular analyses suggest an association to genetic alterations. Most testicular cancer patients present a primary tumour in the testis. Diagnostic examinations include testis palpation and ultrasound, and measurement of serum tumour markers (AFP, ß-HCG, and LDH). Surgical exploration is obligatory for suspected tumours and radical orchidectomy should be performed if a tumour is found. Prognosis and subsequent treatment depends upon the clinical stage and the IGCCCG classification (in case of advanced GCT disease).

scholarly journals The Potential of Artificial Intelligence to Detect Lymphovascular Invasion in Testicular Cancer

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1325
Author(s):  
Abhisek Ghosh ◽  
Korsuk Sirinukunwattana ◽  
Nasullah Khalid Alham ◽  
Lisa Browning ◽  
Richard Colling ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Testicular Cancer ◽  
Germ Cell ◽  
Lymphovascular Invasion ◽  
Automatic Segmentation ◽  
Prognostic Significance ◽  
Germ Cell Tumours ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Tumours ◽  
Whole Slide Images

Testicular cancer is the most common cancer in men aged from 15 to 34 years. Lymphovascular invasion refers to the presence of tumours within endothelial-lined lymphatic or vascular channels, and has been shown to have prognostic significance in testicular germ cell tumours. In non-seminomatous tumours, lymphovascular invasion is the most powerful prognostic factor for stage 1 disease. For the pathologist, searching multiple slides for lymphovascular invasion can be highly time-consuming. The aim of this retrospective study was to develop and assess an artificial intelligence algorithm that can identify areas suspicious for lymphovascular invasion in histological digital whole slide images. Areas of possible lymphovascular invasion were annotated in a total of 184 whole slide images of haematoxylin and eosin (H&E) stained tissue from 19 patients with testicular germ cell tumours, including a mixture of seminoma and non-seminomatous cases. Following consensus review by specialist uropathologists, we trained a deep learning classifier for automatic segmentation of areas suspicious for lymphovascular invasion. The classifier identified 34 areas within a validation set of 118 whole slide images from 10 patients, each of which was reviewed by three expert pathologists to form a majority consensus. The precision was 0.68 for areas which were considered to be appropriate to flag, and 0.56 for areas considered to be definite lymphovascular invasion. An artificial intelligence tool which highlights areas of possible lymphovascular invasion to reporting pathologists, who then make a final judgement on its presence or absence, has been demonstrated as feasible in this proof-of-concept study. Further development is required before clinical deployment.

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