The Value of Tumour Markers in the Detection of Relapse-Lessons Learned from the Swiss Austrian German Testicular Cancer Cohort Study

Stefanie Fischer¹, Christian Rothermundt¹, Odile Stalder², Angelika Terbuch³, Thomas Hermanns⁴, Deborah Zihler⁵, Beat Müller⁶, Christian D Fankhauser⁷, Anita Hirschi-Blickenstorfer⁸, Bettina Seifert⁹, Luis Alex Kluth¹⁰, Mark-Peter Ufe¹¹, Walter Mingrone¹², Arnoud J Templeton¹³, Natalie Fischer¹⁴, Sacha Rothschild¹⁵, Regina Woelky¹⁶, Silke Gillessen^{17

18

19}, Richard Cathomas²⁰

Affiliations

¹ Department of Medical Oncology and Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
² CTU Bern, University of Bern, Bern, Switzerland.
³ Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Comprehensive Cancer Center Graz, Graz, Austria.
⁴ Department of Urology, University Hospital Zurich, Zurich, Switzerland.
⁵ Department of Medical Oncology and Haematology, Cantonal Hospital Aarau, Aarau, Switzerland.
⁶ Department of Medical Oncology, Cantonal Hospital Luzern, Luzern, Switzerland.
⁷ Department of Urology, Cantonal Hospital Luzern, Luzern, Switzerland.
⁸ Onkozentrum Hirslanden, Clinic Hirslanden, Zurich, Switzerland.
⁹ Department of Medical Oncology, Cantonal Hospital Liestal, Basel, Switzerland.
¹⁰ Clinic for Urology, Goethe University, Frankfurt, Germany.
¹¹ Ammerland Klinik, Westerstede, Germany.
¹² Department of Medical Oncology, Cantonal Hospital Olten, Olten, Switzerland.
¹³ Department of Medical Oncology, St. Claraspital and Faculty of Medicine, University of Basel, Switzerland.
¹⁴ Department of Medical Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
¹⁵ Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.
¹⁶ Department of Medical Oncology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
¹⁷ Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
¹⁸ Università della Svizzera Italiana, Lugano, Switzerland.
¹⁹ University of Bern, Bern, Switzerland.
²⁰ Division of Medical Oncology/Haematology, Cantonal Hospital Graubünden, Chur, Switzerland.

PMID: 36874175
PMCID: PMC9976201
DOI: 10.1016/j.euros.2023.01.013

The Value of Tumour Markers in the Detection of Relapse-Lessons Learned from the Swiss Austrian German Testicular Cancer Cohort Study

Stefanie Fischer et al. Eur Urol Open Sci. 2023.

. 2023 Feb 20:50:57-60.

doi: 10.1016/j.euros.2023.01.013. eCollection 2023 Apr.

Authors

Affiliations

¹ Department of Medical Oncology and Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
² CTU Bern, University of Bern, Bern, Switzerland.
³ Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Comprehensive Cancer Center Graz, Graz, Austria.
⁴ Department of Urology, University Hospital Zurich, Zurich, Switzerland.
⁵ Department of Medical Oncology and Haematology, Cantonal Hospital Aarau, Aarau, Switzerland.
⁶ Department of Medical Oncology, Cantonal Hospital Luzern, Luzern, Switzerland.
⁷ Department of Urology, Cantonal Hospital Luzern, Luzern, Switzerland.
⁸ Onkozentrum Hirslanden, Clinic Hirslanden, Zurich, Switzerland.
⁹ Department of Medical Oncology, Cantonal Hospital Liestal, Basel, Switzerland.
¹⁰ Clinic for Urology, Goethe University, Frankfurt, Germany.
¹¹ Ammerland Klinik, Westerstede, Germany.
¹² Department of Medical Oncology, Cantonal Hospital Olten, Olten, Switzerland.
¹³ Department of Medical Oncology, St. Claraspital and Faculty of Medicine, University of Basel, Switzerland.
¹⁴ Department of Medical Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
¹⁵ Department of Medical Oncology, University Hospital Basel, Basel, Switzerland.
¹⁶ Department of Medical Oncology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
¹⁷ Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
¹⁸ Università della Svizzera Italiana, Lugano, Switzerland.
¹⁹ University of Bern, Bern, Switzerland.
²⁰ Division of Medical Oncology/Haematology, Cantonal Hospital Graubünden, Chur, Switzerland.

PMID: 36874175
PMCID: PMC9976201
DOI: 10.1016/j.euros.2023.01.013

Abstract

The tumour markers alpha-fetoprotein (AFP), beta human chorionic gonadotropin (βHCG), and lactate dehydrogenase (LDH) have established roles in the management and follow-up of testicular cancer. While a tumour marker rise can serve as an indicator of relapse, the frequency of false-positive marker events has not been studied systematically in larger cohorts. We assessed the validity of serum tumour markers for the detection of relapse in the Swiss Austrian German Testicular Cancer Cohort Study (SAG TCCS). This registry was set up to answer questions on the diagnostic performance and impact of imaging and laboratory tests in the management of testicular cancer, and has included 948 patients between January 2014 and July 2021.A total of 793 patients with a median follow-up of 29.0 mo were included. In total, 71 patients (8.9%) had a proven relapse, which was marker positive in 31 patients (43.6%). Of all patients, 124 (15.6%) had an event of a false-positive marker elevation. The positive predictive value (PPV) of the markers was limited, highest for βHCG (33.8%) and lowest for LDH (9.4%). PPV tended to increase with higher levels of elevation. These findings underline the limited accuracy of the conventional tumour markers to indicate or rule out a relapse. Especially, LDH as part of routine follow-up should be questioned.

Patient summary: With the diagnosis of testicular cancer, the three tumour markers alpha-fetoprotein, beta human chorionic gonadotropin, and lactate dehydrogenase are routinely measured during follow-up to monitor for relapse. We demonstrate that these markers are often falsely elevated, and, by contrast, many patients do not have marker elevations despite a relapse. The results of this study can lead to improved use of these tumour markers during follow-up of testis cancer patients.

Keywords: Alpha-fetoprotein; Beta human chorionic gonadotropin; Lactate dehydrogenase; Testicular cancer follow-up; Tumour markers.

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Comment in

Serum tumour markers for testicular cancer recurrence.
Murray MJ, Scarpini CG, Coleman N. Murray MJ, et al. Nat Rev Urol. 2023 Aug;20(8):459-460. doi: 10.1038/s41585-023-00782-7. Nat Rev Urol. 2023. PMID: 37254014 No abstract available.

References

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The Value of Tumour Markers in the Detection of Relapse-Lessons Learned from the Swiss Austrian German Testicular Cancer Cohort Study

Affiliations

The Value of Tumour Markers in the Detection of Relapse-Lessons Learned from the Swiss Austrian German Testicular Cancer Cohort Study

Authors

Affiliations

Abstract

Comment in

References

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