Tumor markers in testicular germ cell tumors related to the stage of the disease at the time of diagnosis.

A series of 170 consecutive patients with testicular germ cell tumors (88 seminomas and 82 non-seminomas) had preoperative serum samples and primary tumor tissue examined for the presence of the tumor markers, alphafetoprotein (AFP) and human chorionic gonadotropin (HCG) by immunologic techniques. Staging was performed, using a clinico- radiological system, i.e., stage I, tumor confined to testis; stage II, metastases to abdominal lymph nodes only: stage III, metastases to supradiaphragmatic lymph nodes and/or extranodal disease. Seminoma:all 36% had stage II+III disease. 55% of the patients with AFP had localized disease, and 45% had stage II+III. The frequency of patients with stage I non-seminoma with raised serum HCG was 63% compared to 37% in stage II+III. Within the group of HCG-positive non-seminomas, 60% were in stage I and 40% in stage II. Since a high frequency of patients with metastatic disease did not occur among the patients with AFP or HCG in preoperative serum samples or in primary tumor tissue, we conclude that neither AFP nor HCG are especially associated with metastatic properties. The higher frequency of patients with raised serum values among all patients with metastatic disease compared to localized disease may only reflect a greater tumor burden.