title: The management of patients with clinical stage I nonseminomatous testicular tumors and persistently elevated serologic markers.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Medicine (Division of Hematology/Oncology) and Urology, Indiana University School of Medicine, Indianapolis.
authors.forename: S B
authors.initials: SB
authors.lastname: Saxman
authors.forename: C R
authors.initials: CR
authors.lastname: Nichols
authors.forename: R S
authors.initials: RS
authors.lastname: Foster
authors.forename: J E
authors.initials: JE
authors.lastname: Messemer
authors.forename: J P
authors.initials: JP
authors.lastname: Donohue
authors.forename: L H
authors.initials: LH
authors.lastname: Einhorn
mesh_terms: D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D005500:Follow-Up Studies; D018237:Germinoma / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009367:Neoplasm Staging; D009919:Orchiectomy; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins