The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors.
BACKGROUND
To determine the impact of diagnostic serum and/or cerebrospinal fluid (CSF) alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (b-HCG) elevations on survival in newly diagnosed patients with central nervous system germ cell tumors (CNS GCT) treated with chemotherapy with the intent to avoid irradiation.


METHODS
Seventy-five patients with newly diagnosed CNS GCT enrolled in two sequential internationally conducted clinical trials with serum and CSF AFP and b-HCG levels available from initial diagnosis were retrospectively analyzed. Subjects received platinum based chemotherapy and were followed with serial imaging and tumor marker evaluations.


RESULTS
The 5-year overall survival (OS) and event free survival (EFS) for patients with normal tumor markers compared with those with elevated markers at diagnosis was 78% (95% CI 51-91%) versus 60% (95% CI 46-72%) (P = 0.08) and 22% (95% CI 7-43%) versus 28% (95% CI 16-40%) (P = 0.68). The hazard ratio of death for patients with elevated markers was 1.9 times as high as that for those with normal markers (95% CI 0.58-6.5) after adjusting for other baseline characteristics. There was no observed difference in survival among patients with histologically confirmed germinomas, irrespective of level of b-HCG.


CONCLUSIONS
Patients with elevated tumor markers appear to have poorer OS independent of tumor histology, although these differences do not reach statistical significance (P < or = 0.05). No differences were observed in EFS between groups likely due to the poor response of chemotherapy only approach to patients with normal markers. b-HCG elevations in biopsy proven germinomas do not seem to alter a patient's prognosis.
Kim
AeRang
A
New York University Medical Center, New York, New York, USA. kimaer@mail.nih.gov
Ji
Lingyun
L
Balmaceda
Casilda
C
Diez
Blanca
B
Kellie
Stewart J
SJ
Dunkel
Ira J
IJ
Gardner
Sharon L
SL
Sposto
Richard
R
Finlay
Jonathan L
JL
D000293:Adolescent; D014408:Biomarkers, Tumor / Q000097:blood* / Q000134:cerebrospinal fluid*; D001932:Brain Neoplasms / Q000097:blood / Q000134:cerebrospinal fluid / Q000401:mortality*; D002648:Child; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood / Q000134:cerebrospinal fluid; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000134:cerebrospinal fluid / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis / Q000134:cerebrospinal fluid
C097353:AFP protein, human; D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins