The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors

• Published in: Pediatric Blood & Cancer Vol. 51; no. 6; pp. 768 - 773
• Main Authors: Kim, AeRang, Ji, Lingyun, Balmaceda, Casilda, Diez, Blanca, Kellie, Stewart J., Dunkel, Ira J., Gardner, Sharon L., Sposto, Richard, Finlay, Jonathan L.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2008
• Subjects: Adolescent; alpha-Fetoproteins - analysis; alpha-Fetoproteins - cerebrospinal fluid; Biomarkers, Tumor - blood; Biomarkers, Tumor - cerebrospinal fluid; Brain Neoplasms - blood; Brain Neoplasms - cerebrospinal fluid; Brain Neoplasms - mortality; Child; Chorionic Gonadotropin, beta Subunit, Human - blood; Chorionic Gonadotropin, beta Subunit, Human - cerebrospinal fluid; Disease-Free Survival; Female; germ cell tumors; Humans; Male; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal - blood; Neoplasms, Germ Cell and Embryonal - cerebrospinal fluid; Neoplasms, Germ Cell and Embryonal - mortality; pediatric neuro-oncology; Prognosis; Retrospective Studies; survival; Survival Rate; Treatment Outcome; tumor markers
• ISSN: 1545-5009; 1545-5017; 1545-5017; 1096-911X
• DOI: 10.1002/pbc.21741

Background To determine the impact of diagnostic serum and/or cerebrospinal fluid (CSF) alpha‐fetoprotein (AFP) and beta‐human chorionic gonadotropin (b‐HCG) elevations on survival in newly diagnosed patients with central nervous system germ cell tumors (CNS GCT) treated with chemotherapy with the intent to avoid irradiation. Procedure Seventy‐five patients with newly diagnosed CNS GCT enrolled in two sequential internationally conducted clinical trials with serum and CSF AFP and b‐HCG levels available from initial diagnosis were retrospectively analyzed. Subjects received platinum based chemotherapy and were followed with serial imaging and tumor marker evaluations. Results The 5‐year overall survival (OS) and event free survival (EFS) for patients with normal tumor markers compared with those with elevated markers at diagnosis was 78% (95% CI 51–91%) versus 60% (95% CI 46–72%) (P = 0.08) and 22% (95% CI 7–43%) versus 28% (95% CI 16–40%) (P = 0.68). The hazard ratio of death for patients with elevated markers was 1.9 times as high as that for those with normal markers (95% CI 0.58–6.5) after adjusting for other baseline characteristics. There was no observed difference in survival among patients with histologically confirmed germinomas, irrespective of level of b‐HCG. Conclusions Patients with elevated tumor markers appear to have poorer OS independent of tumor histology, although these differences do not reach statistical significance (P ≤ 0.05). No differences were observed in EFS between groups likely due to the poor response of chemotherapy only approach to patients with normal markers. b‐HCG elevations in biopsy proven germinomas do not seem to alter a patient's prognosis. Pediatr Blood Cancer 2008;51:768–773. © 2008 Wiley‐Liss, Inc.