Abstract
We have assessed the tumour markers placental alkaline phosphatase (PLAP), lactate dehydrogenase (LD), and human chorionic gonadotrophin (beta HCG) using 2,000 serum samples from 286 patients with seminoma. The ROC curves show that no one marker performs adequately for the detection of disease either at initial staging or during follow-up. We used a Markov model heuristically to devise strategies, in which marker results were assessed in combination, which might be useful in clinical practice. We found that the best strategy was to consider a test result abnormal only if either the beta HCG was greater than 6 Ul-1 or the LD was greater than 400 U l-1 and the PLAP level was greater than 60 U l-1. This will detect about 50% of patients with disease and the false-positive rate is 2%. In practical terms this means that PLAP need only be estimated in patients whose beta HCG is less than 6 IU l-1 and whose LD is greater than 400 U l-1.
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Selected References
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- Anstiss C. L., Green S., Fishman W. H. An automated technique for segregating populations with a high incidence of Regan isoenzyme in serum. Clin Chim Acta. 1971 Jul;33(2):279–286. doi: 10.1016/0009-8981(71)90484-0. [DOI] [PubMed] [Google Scholar]
- Beck J. R., Pauker S. G. The Markov process in medical prognosis. Med Decis Making. 1983;3(4):419–458. doi: 10.1177/0272989X8300300403. [DOI] [PubMed] [Google Scholar]
- De Broe M. E., Pollet D. E. Multicenter evaluation of human placental alkaline phosphatase as a possible tumor-associated antigen in serum. Clin Chem. 1988 Oct;34(10):1995–1999. [PubMed] [Google Scholar]
- Dieckmann K. P., Düe W., Bauer H. W. Seminoma testis with elevated serum beta-HCG--a category of germ-cell cancer between seminoma and nonseminoma. Int Urol Nephrol. 1989;21(2):175–184. doi: 10.1007/BF02550806. [DOI] [PubMed] [Google Scholar]
- Duchesne G. M., Horwich A., Dearnaley D. P., Nicholls J., Jay G., Peckham M. J., Hendry W. F. Orchidectomy alone for stage I seminoma of the testis. Cancer. 1990 Mar 1;65(5):1115–1118. doi: 10.1002/1097-0142(19900301)65:5<1115::aid-cncr2820650513>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
- Duncan W., Munro A. J. The management of testicular seminoma: Edinburgh 1970-1981. Br J Cancer. 1987 Apr;55(4):443–448. doi: 10.1038/bjc.1987.87. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Epenetos A. A., Munro A. J., Tucker D. F., Gregory W., Duncan W., MacDougall R. H., Faux M., Travers P., Bodmer W. F. Monoclonal antibody assay of serum placental alkaline phosphatase in the monitoring of testicular tumours. Br J Cancer. 1985 May;51(5):641–644. doi: 10.1038/bjc.1985.96. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fosså A., Fosså S. D. Serum lactate dehydrogenase and human choriogonadotrophin in seminoma. Br J Urol. 1989 Apr;63(4):408–415. doi: 10.1111/j.1464-410x.1989.tb05228.x. [DOI] [PubMed] [Google Scholar]
- Gail M. H., Muenz L., McIntire K. R., Radovich B., Braunstein G., Brown P. R., Deftos L., Dnistrian A., Dunsmore M., Elashoff R. Multiple markers for lung cancer diagnosis: validation of models for advanced lung cancer. J Natl Cancer Inst. 1986 May;76(5):805–816. [PubMed] [Google Scholar]
- Lahousen M., Stettner H., Pickel H., Urdl W., Pürstner P. The predictive value of a combination of tumor markers in monitoring patients with ovarian cancer. Cancer. 1987 Nov 1;60(9):2228–2232. doi: 10.1002/1097-0142(19871101)60:9<2228::aid-cncr2820600921>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
- Makuch R. W., Muenz L. R. Evaluating the adequacy of tumor markers to discriminate among distinct populations. Semin Oncol. 1987 Jun;14(2):89–101. [PubMed] [Google Scholar]
- Munro A. J., Warde P. R. The use of a Markov process to simulate and assess follow-up policies for patients with malignant disease: surveillance for stage I nonseminomatous tumors of the testis. Med Decis Making. 1991 Apr-Jun;11(2):131–139. doi: 10.1177/0272989X9101100211. [DOI] [PubMed] [Google Scholar]
- Nielsen O. S., Munro A. J., Duncan W., Sturgeon J., Gospodarowicz M. K., Jewett M. A., Malkin A., Thomas G. M. Is placental alkaline phosphatase (PLAP) a useful marker for seminoma? Eur J Cancer. 1990;26(10):1049–1054. doi: 10.1016/0277-5379(90)90049-y. [DOI] [PubMed] [Google Scholar]
- Taylor R. E., Duncan W., Horn D. B. Lactate dehydrogenase as a marker for testicular germ-cell tumours. Eur J Cancer Clin Oncol. 1986 Jun;22(6):647–653. doi: 10.1016/0277-5379(86)90161-6. [DOI] [PubMed] [Google Scholar]
- von Eyben F. E., Blaabjerg O., Petersen P. H., Hørder M., Nielsen H. V., Kruse-Andersen S., Parlev E. Serum lactate dehydrogenase isoenzyme 1 as a marker of testicular germ cell tumor. J Urol. 1988 Nov;140(5):986–990. doi: 10.1016/s0022-5347(17)41906-9. [DOI] [PubMed] [Google Scholar]
