RESUMEN
OBJECTIVES: Malignant tumor is a top-ranking cause of pediatric (>1-year) mortality in America and Europe. Among pediatric tumors, germ cell tumors (GCT) and gonadal tumors rank fourth (6%) by the Surveillance, Epidemiology, and End Results (SEER) program (seer.cancer.gov). Continuous research on tumor markers harnesses their full potential in tumor detection and management. We evaluated the effectiveness of beta-human chorionic gonadotropin (ß-hCG) and Alpha-fetoprotein (AFP) in Romanian children with (para)gonadal tumors and cysts, determining their accuracy in detecting malignancy, tumor-type, stage, complications, prognosis, and treatment response. METHODS: A 10-year retrospective study of AFP and ß-hCG in 134 children with cysts and (para)gonadal tumors aged one month to 17 years was performed. RESULTS: AFP/ß-hCG was unelevated in patients with cysts and nonmalignant tumors. Forty-eight/86 patients (43 GCT and 5 non-GCT) with malignant tumors had elevated AFP/ß-hCG, 3/48 patients had recurrences, and 25/48 had mixed-GCT (68% had elevated AFP + ß-hCG). All 30 patients with Yolk sac tumors (YST) or their components had elevated AFP. Area under the curve, sensitivity and specificity for GCT were: AFP + ß-hCG- 0.828, 67.2%, 100%; AFP- 0.813, 64.1%, 100%; and ß-hCG- 0.664, 32.8%, 100%. Two patients whose AFP/ß-hCG levels remained elevated died. Common mixed-GCT components were YST-80% and embryonal carcinoma-72%. Thirty of 34 metastasis cases were GCT, with 26/34 patients having elevated AFP/ß-hCG. CONCLUSIONS: AFP/ß-hCG detects malignant GCT and can determine tumor-type. GCT patients with markedly elevated AFP + ß-hCG had poor prognosis, especially if recurrence or metastasis was present. Recurrence is unrelated to elevated AFP/ß-hCG. The tumor components and quantity present determine AFP/ß-hCG values in mixed-GCT.