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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.
Wissenschaftlicher Artikel/Review - 20.02.2023
Fischer Stefanie, Rothermundt Christian, Stalder Odile, Terbuch Angelika, Hermanns Thomas, Zihler Deborah, Müller-Stich Beat P, Fankhauser Christian Daniel, Hirschi-Blickenstorfer Anita, Seifert Bettina, Alex Kluth Luis, Ufe Mark-Peter, Mingrone Walter, Templeton Arnoud J, Fischer Natalie Fischer, Rothschild Sacha I, Woelky Regina, Gillessen Silke, Cathomas Richard
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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.