title: Variations in normal serum alpha-fetoprotein (AFP) levels in patients with testicular cancer on surveillance.
abstract: BACKGROUND
  The aim of this study was to assess fluctuations in normal serum alpha-fetoprotein (AFP) levels in patients with germ cell cancer. Marked variations occur after serum AFP levels normalize, creating anxiety among patients and physicians during surveillance.
  
  
  METHODS
  We conducted a retrospective review of patients with germ cell tumors in clinical remission, who had normal AFP levels and were followed at our center from 1991 to 2009. 72 patients, with a median follow-up of 50 months, were identified.
  
  
  RESULTS
  Of the 72 patients, 57 (79%) had a non-seminomatous germ cell histology, and 15 (21%) had seminomas. Seminomas were included as controls as serum AFP levels do not increase in this group. 68 patients underwent orchiectomy, and 50 patients received systemic chemotherapy. The majority of patients (93%) demonstrated fluctuations in serum AFP. There was no difference in the mean AFP values between patients with seminona (2.95 ng/ml) and those with non-seminomatous germ cell tumors (3.3 ng/ml) (standard deviation 1.01 ng/ml).
  
  
  CONCLUSIONS
  Marked variations occur after serum AFP levels normalize in patients undergoing surveillance. Fluctuating AFP levels within normal limits did not result in relapse in our cohort of patients with extended follow-up.
authors.affiliation: Division of Medical Oncology, Stanford University, CA 94305, USA.
authors.forename: Priti
authors.initials: P
authors.lastname: Patel
authors.forename: Raymond
authors.initials: R
authors.lastname: Balise
authors.forename: Sandy
authors.initials: S
authors.lastname: Srinivas
mesh_terms: D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood*; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D015203:Reproducibility of Results; D012307:Risk Factors; D018239:Seminoma / Q000097:blood* / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000097:blood* / Q000453:epidemiology*; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins