title: Significance of primary tumor size and preorchiectomy serum tumor marker level in predicting pathologic stage at retroperitoneal lymph node dissection in clinical Stage A nonseminomatous germ cell tumors.
abstract: OBJECTIVE
  To determine whether the size of the primary tumor and degree of preorchiectomy serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) elevation predict for retroperitoneal pathologic findings in patients with clinical Stage A nonseminomatous germ cell tumor undergoing primary retroperitoneal lymph node dissection.
  
  
  METHODS
  The testicular cancer database was queried to identify patients with clinical Stage A nonseminomatous germ cell tumor with normalization of serum tumor markers after orchiectomy who had undergone retroperitoneal lymph node dissection. A total of 779 patients were identified. The preorchiectomy serum tumor marker level was recorded and categorized into the following subsets: AFP: less than 20 (normal), 20 to 100, 100 to 1000, and more than 1000 ng/dL; and beta-hCG: less than 5.0 (normal), 5 to 100, 100 to 1000, and more than 1000. The association between AFP, beta-hCG, and primary tumor size and retroperitoneal pathologic findings was determined.
  
  
  RESULTS
  The retroperitoneal pathologic examination revealed metastatic disease in 207 patients (26.6%). The preorchiectomy serum beta-hCG level, as a categorical variable, was not predictive of positive retroperitoneal pathologic findings (P = 0.187). The preorchiectomy serum AFP did predict for positive retroperitoneal pathologic findings, with lower serum AFP levels associated with a greater incidence of retroperitoneal metastasis (P <0.001). The primary tumor size was not predictive of positive retroperitoneal pathologic findings (P = 0.113).
  
  
  CONCLUSIONS
  Neither the primary tumor size nor the preorchiectomy beta-hCG level was predictive of retroperitoneal metastases. However, a normal preorchiectomy AFP level was associated with a greater incidence of retroperitoneal metastases.
authors: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. stdbeck@iupui.edu
authors: Stephen D W
authors: SD
authors: Beck
authors: Richard S
authors: RS
authors: Foster
authors: Richard
authors: R
authors: Bihrle
authors: John P
authors: JP
authors: Donohue
mesh_terms: D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D009919:Orchiectomy; D011237:Predictive Value of Tests; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins