Barcelona, Spain ( Approximately 20% of seminoma germ cell tumors (GCTs) have an elevated level of serum HCG at the time of first diagnosis. The prognostic role of different HCG marker levels is not clear. In this abstract, the authors sought to evaluate the prognostic impact of elevated HCG levels at first diagnosis.

Patients included in this study had confirmed seminomatous GCT, advanced disease, and elevated HCG levels at diagnosis. The authors identified a total of 392 patients meeting this criteria. The median age was 39.5 years. Median HCG levels pre- and post- orchiectomy were 33 (range 2-280,000) and 37 (range 0-36,000). 78% of tumors were gonadal. 69% had UICC stage 2 disease and the remaining 31% had stage 3 disease. Breakdown of tumors by IGCCCG criteria were: 82% good risk, 12% intermediate risk, and 6% had missing information.

The authors then performed univariate and multivariate analysis to identify risk factors associated with relapse-free survival (RFS) and overall survival (OS). On univariate analysis, no factors were associated with RFS, however, age, HCG levels pre-orchiectomy, LDH levels pre-orchiectomy, and LDH levels post-orchiectomy were all associated with survival. On multivariate analysis the following variables were associated with increased mortality, LDH > 1.5 times the upper limit of normal pre- or post-orchiectomy (HR 3.88, p = 0.01), age > 40 (HR 5.97, p = 0.02), HCG > 2000 UI/l (HR 3.59, p = 0.048).

ESMO2019 G3 Table2

The authors concluded that pre-orchiectomy HCG > 2000 UI/l, LDH > 1.5 time the upper limit of normal, and age > 40 should be used to risk stratify patients with HCG positive seminoma.  Dr. Kollmannsberger discussion of this abstract in an “Invited Discussant: Germ Cell Tumor Studies and Renal Cell Carcinoma Disease Management Methods”. 

Presented by: Christoph Seidel, MD, Medical Oncologist at University Medical Center Hamburg

Written by: Jacob Berchuck, MD, Medical Oncology Fellow at the Dana-Farber Cancer Institute, Twitter: @jberchuck at the 2019 European Society for Medical Oncology annual meeting, ESMO 2019 #ESMO19, 27 Sept – 1 Oct 2019 in Barcelona, Spain