Elevations of alpha-fetoprotein in patients undergoing chemotherapy for pure testicular seminoma: a retrospective cohort study.
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All Authors
Costelloe, SJ.
Spencer, JD.
Humphries, K.
Stark, D.
Dunwoodie, E.
LTHT Author
Spencer, Jennifer
Humphries, Kathryn
Stark, Dan
Dunwoodie, Elaine
Humphries, Kathryn
Stark, Dan
Dunwoodie, Elaine
LTHT Department
Pathology
Blood Sciences
Leeds Children's Hospital
Children & Teenage Oncology & Haematology
Oncology
Blood Sciences
Leeds Children's Hospital
Children & Teenage Oncology & Haematology
Oncology
Non Medic
Clinical Scientist
Publication Date
2025
Item Type
Journal Article
Language
Subject
Subject Headings
Abstract
BACKGROUND: alpha-Fetoprotein (AFP) is conventionally absent in testicular classical seminoma (TCS). However, moderate AFP elevations can occur in TCS patients, as observed at this and other centres, which can be challenging to diagnostic and management practices.
METHODS: This retrospective cohort study considered AFP concentration in the context of germ-cell tumour diagnosis and characterisation at baseline (BL), disease status during chemotherapy, and long-term surveillance. The study considered patients with histologically diagnosed stage 1 TCS requiring chemotherapy over six years. For those with AFP above the reference interval at BL, histological imaging, case notes, and biochemical data were reviewed from BL to surveillance completion. Outcomes included AFP changes, diagnoses, therapy, disease progression, and death.
RESULTS: Of the 175 patients included, eight (4.6%) had elevated AFP at BL. Of these, two showed statistically but not clinically significant AFP changes during therapy, while six had moderate, stable AFP elevations with no changes in diagnosis during follow-up. During therapy, one patient developed metastases, and one died of causes likely unrelated to their TCS.
CONCLUSIONS: Mild elevations of AFP in TCS may lead to diagnostic uncertainty or inappropriate management and investigation. However, AFP changes, alongside imaging, did not affect diagnosis, therapy, or follow-up at this centre for any of the patients examined. A subgroup of TCS patients has stable, moderate AFP elevations unrelated to tumour aetiology.
Journal
BMC Cancer