Shuya Kandori, Koji Kawai, Ken Tanaka, Takashi Kawahara, Atsushi Ikeda, Ryutaro Ishitsuka, Tomokazu Kimura, Takahiro Kojima, Akira Joraku, Jun Miyazaki, Hiroyuki Nishiyama
Hinyokika kiyo. Acta urologica Japonica 2017 AprHistologically pure seminoma with elevated alpha-fetoprotein (AFP), so-called AFP-positive seminoma, is rare. It is recommended that patients with AFP-positive seminoma be managed as non-seminoma, but the clinical features and prognosis of this disease are not fully understood. In this study, we retrospectively analyzed 6 cases of metastatic AFP-positive seminoma at Tsukuba University Hospital (TUH). AFP was elevated before induction chemotherapy in 4 patients with an average of 1,372 ng/ml. In the remaining 2 patients, AFP became elevated during or after induction chemotherapy. In all 4 patients examined, AFPL3% was abnormally increased. As induction chemotherapy, all patients received bleomycin, etoposide and cisplatin (BEP), which was then followed by etoposide, ifosfamide and cisplatin (VIP) in 3 patients. After or during induction chemotherapy, 3 patients suffered from disease progression accompanied by AFP elevation. All 3 were treated by salvage chemotherapy and surgery. Four patients underwent retroperitoneal lymph node dissection (RPLND) after induction chemotherapy ; the pathological findings were necrosis in 3 patients, and viable nonseminomatous cancer in 1 patient. Furthermore, RPLND was performed as salvage surgery in 3 patients ; the pathological findings were necrosis, viable nonseminomatous cancer and teratoma with malignant transformation, respectively. The 5-year progression-free survival rate of the 6 patients was 50%, which is somewhat inferior to that of poor-prognosis non-seminoma patients treated at TUH. One patient ultimately died of cancer, and the remaining 5 are in remission with a median follow-up of 58 months. The present study demonstrates that AFP-positive seminoma patients have a higher risk of relapse compared to non-seminoma patients.
Shuya Kandori, Koji Kawai, Ken Tanaka, Takashi Kawahara, Atsushi Ikeda, Ryutaro Ishitsuka, Tomokazu Kimura, Takahiro Kojima, Akira Joraku, Jun Miyazaki, Hiroyuki Nishiyama. A Clinicopathologic Study of 6 Patients with Histologically Pure Seminoma But Elevated Serum Alpha-Fetoprotein]. Hinyokika kiyo. Acta urologica Japonica. 2017 Apr;63(4):139-143
PMID: 28506050
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