American Society of Clinical Oncology Clinical Practice Guideline on Uses of Serum Tumor Markers in Adult Males With Germ Cell Tumors
American Society of Clinical Oncology Clinical Practice Guideline on Uses of Serum Tumor Markers in Adult Males With Germ Cell Tumors
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DOI：
10.1200/jco.2009.26.4481
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发表时间：
2010-07-10
影响因子：
45.3
通讯作者：
Hayes, Daniel F.
中科院分区：
文献类型：
--
作者：
Gilligan, Timothy D.;Seidenfeld, Jerome;Hayes, Daniel F.
目的为生殖细胞肿瘤血清标志物的合理应用提供建议。方法检索MEDLINE和EMBASE检索相关英文文献。主要结果包括预测决策对结果影响的标记物准确性。次要结局包括标志物升高的患者比例和升高作为预后因素的统计学检验。一个专家小组根据82份报告的数据制定了共识指导方针。没有研究直接比较有和没有标记物测定的决策结果。该研究发现很少有前瞻性研究，也没有随机对照试验；大多数是回顾性研究。由于缺乏主要结局的数据，大多数专家组的建议都是基于次要结局（复发率和复发时间）。建议专家组建议不要使用标记物筛查gct，以决定是否需要睾丸切除术，或为原发不明的癌症患者选择治疗方法。为了对睾丸非精原细胞瘤患者进行分期，专家小组建议在睾丸切除术前后和睾丸外非精原细胞瘤患者化疗前测量三种标志物（甲胎蛋白[AFP]、人绒毛膜促性腺激素[hCG]和乳酸脱氢酶[LDH]）。他们还建议在腹膜后淋巴结清扫前不久和非精原细胞瘤每次化疗周期开始时测量AFP和hCG，并定期监测复发。专家组建议对精原细胞瘤和睾丸切除术前升高的患者测量切除后hCG和LDH。他们建议不要使用标志物来指导或监测精原细胞瘤的治疗或检测i期治疗患者的复发。然而，他们建议测量hCG和AFP来监测晚期精原细胞瘤患者的复发。[J]中华临床杂志，28(3):388- 394。(C) 2010年由美国临床肿瘤学会出版
PurposeTo provide recommendations on appropriate uses for serum markers of germ cell tumors (GCTs).MethodsSearches of MEDLINE and EMBASE identified relevant studies published in English. Primary outcomes included marker accuracy to predict the impact of decisions on outcomes. Secondary outcomes included proportions of patients with elevated markers and statistical tests of elevations as prognostic factors. An expert panel developed consensus guidelines based on data from 82 reports.ResultsNo studies directly compared outcomes of decisions with versus without marker assays. The search identified few prospective studies and no randomized controlled trials; most were retrospective series. Lacking data on primary outcomes, most Panel recommendations are based on secondary outcomes (relapse rates and time to relapse).RecommendationsThe Panel recommended against using markers to screen for GCTs, to decide whether orchiectomy is indicated, or to select treatment for patients with cancer of unknown primary. To stage patients with testicular nonseminomas, the Panel recommended measuring three markers (alpha-fetoprotein [AFP], human chorionic gonadotropin [hCG], and lactate dehydrogenase [LDH]) before and after orchiectomy and before chemotherapy for those with extragonadal nonseminomas. They also recommended measuring AFP and hCG shortly before retroperitoneal lymph node dissection and at the start of each chemotherapy cycle for nonseminoma, and periodically to monitor for relapse. The Panel recommended measuring postorchiectomy hCG and LDH for patients with seminoma and preorchiectomy elevations. They recommended against using markers to guide or monitor treatment for seminoma or to detect relapse in those treated for stage I. However, they recommended measuring hCG and AFP to monitor for relapse in patients treated for advanced seminoma. J Clin Oncol 28:3388-3404. (C) 2010 by American Society of Clinical Oncology