The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors Journal Article
| Authors: | Kim, A.; Ji, L.; Balmaceda, C.; Diez, B.; Kellie, S. J.; Dunkel, I. J.; Gardner, S. L.; Sposto, R.; Finlay, J. L. |
| Article Title: | The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors |
| Abstract: | 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. © 2008 Wiley-Liss, Inc. |
| Keywords: | survival; adolescent; adult; cancer chemotherapy; cancer survival; child; preschool child; school child; treatment outcome; treatment response; disease-free survival; survival rate; retrospective studies; major clinical study; overall survival; clinical trial; brain neoplasms; neoplasm staging; tumor markers, biological; retrospective study; tumor marker; histology; central nervous system tumor; central nervous system; cerebrospinal fluid; irradiation; neoplasms, germ cell and embryonal; hazard ratio; germ cell tumor; germ cell tumors; serum; chorionic gonadotropin beta subunit; chorionic gonadotropin, beta subunit, human; alpha fetoprotein; tumor markers; alpha-fetoproteins; pediatric neuro-oncology |
| Journal Title: | Pediatric Blood and Cancer |
| Volume: | 51 |
| Issue: | 6 |
| ISSN: | 1545-5009 |
| Publisher: | Wiley Periodicals, Inc |
| Date Published: | 2008-12-01 |
| Start Page: | 768 |
| End Page: | 773 |
| Language: | English |
| DOI: | 10.1002/pbc.21741 |
| PUBMED: | 18802946 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 5" - "Export Date: 17 November 2011" - "CODEN: PBCEA" - "Source: Scopus" |
