Detection of recurrence in patients with clinical stage I nonseminomatous testicular germ cell tumors and consequences for further follow-up: a single-center 10-year experience.

PURPOSE: A wait-and-see policy for patients with stage I nonseminomatous testicular germ cell tumors (NSTGCT) was evaluated in a prospective study. The frequency and time of recurrence, detection of recurrence, and presence of unfavorable prognostic factors were investigated. PATIENTS AND METHODS: During the period 1982 to 1992, 154 patients with stage I NSTGCT (median age, 29 years) underwent orchidectomy and were monitored at follow-up evaluation with physical examinations, alfafetoprotein (AFP) and beta-human choriogonadotropin (hCG) levels, chest x-rays (CXR), and computed tomographic (CT) scans of the abdomen and chest. Multivariate logistic regression analyses were performed to identify prognostic factors. RESULTS: During a median follow-up period of 7 years (range, 2 to 12), recurrence was found in 42 patients (27.3%). All cases of recurrence were detected within 2 years, 90% in the first year after orchidectomy. In 29 patients (69.0%), recurrence was detected in the abdominal lymph nodes. Nine patients (21.4%) had metastases in the retroperitoneum and mediastinum and/or lungs, and four patients (9.6%) had metastases only in the mediastinum or lungs. The majority of recurrences (97.6%) were detected by tumor markers and CT scans. Recurrence was related to the presence of vascular invasion, embryonal carcinoma (E), elevated preoperative hCG level, and absence of mature teratoma (M). Only vascular invasion was an independent risk factor. After polychemotherapy treatment for recurrence, the survival rate for the total group was 98.7%. CONCLUSION: The wait-and-see policy is a reliable method for follow-up monitoring of patients with stage I NSTGCT. Even in patients with unfavorable prognostic factors, it is justified to await the possible appearance of metastases. For the future, it is recommended that CXR be omitted from the schedule, and it might be feasible to discontinue follow-up evaluations after 5 years.

Aggressive chemotherapy for acute leukaemia frequently causes intestinal protein leakage.

Cytostatic drugs are known to produce disturbances in intestinal absorption of carbohydrates. To further explore the gastrointestinal (GI) toxicity of cytostatic therapy, 37 patients with acute leukemia were investigated during and/or after remission induction courses by the use of the differential sugar absorption test (DSAT) and the intestinal clearance of alpha-1-antitrypsin (ClAAT). The ratio of the lactulose to the mannitol excretion in the urine was found abnormal in 44% of the tests. The ClAAT was increased in 74% of tests. The tests results differed considerably from patient to patient and depended on the chemotherapy course; correlation between the tests was low, probably indicating the unrelated pathophysiological processes were measured. After haematological regeneration, abnormal test results normalised. It is concluded that aggressive chemotherapy not only causes a reduction in the absorption of sugars, but commonly also protein leakage. These GI side-effects are reversible, and the application of both tests in combination provides a practical and reproducible method for investigation of GI toxicity in patients treated with cytostatic drugs.

Tissue polypeptide-specific antigen: a discriminative parameter between prostate cancer and benign prostatic hypertrophy.

The serum concentration of the cell proliferation marker TPS (tissue polypeptide-specific antigen) was compared with the tumour marker PSA (prostate specific antigen). PSA was found elevated in 50% of the benign prostatic hypertrophy (BPH) patients, in 88% of the patients with active prostate cancer and in 40% of the patients who were in an inactive phase. For TPS these values were 6, 34 and 0%, respectively. The metastatic progression was biochemically mirrored by pronounced elevations of PSA and TPS. These data suggest that TPS might be a valuable adjunct in the diagnosis and follow-up of patients with prostate cancer, especially in differentiating benign from malignant deterioration of the disease.

Alpha-fetoprotein-lectin binding as a marker of tumour activity or liver damage.

To establish whether alpha-fetoprotein (AFP) produced in the early post-treatment phase of a patient with a germ cell tumour of the testis or the ovary originates from the tumour or is due to an underlying disturbance in liver function, the binding of AFP to concanavalin A (Con A) was investigated as a discriminative variable. A two-step assay is described that can distinguish the type of AFP produced at levels as low as 10 ng/ml. A Con A-binding ratio of 12-43% was found in the patients with disseminated germ cell tumours and in patients with AFP-positive gastrointestinal carcinomas. AFP from the liver gives ratios below 10%.

Plasma spermidine concentrations as early indication of response to therapy in human myeloma.

Eighteen patients with melphalan refractory myeloma were treated with vindesine and prednisone. Plasma spermidine concentrations were measured by radioimmunoassay before and after a single vindesine injection. Seven patients showed a significant rise of plasma spermidine after vindesine and five of these showed a clinical response on further evaluation. Of the 11 patients who did not show raised spermidine concentrations, 10 did not respond to the therapy. The correlation between clinical response/rise of spermidine and between non-response/no rise of spermidine was statistically significant (p less than 0.05). Pretreatment spermidine concentrations did not distinguish those who responded to treatment nor did they differ in patients and controls.

Wait-and-see policy in clinical stage I non-seminomatous germ cell tumors of the testis.

Thirty-three patients with a non-seminomatous germ cell tumor of the testis in clinical stage I were treated only by orchidectomy. The very careful follow-up--with tumor marker assays every 3 weeks, chest X-rays every 6 weeks and CT-scans of the lungs and retroperitoneum every 3 months--revealed metastases in 7 of the patients (21%). All these relapses were diagnosed within 6 months of the orchidectomy. Para-aortic node metastases were found in 5 of the 7 patients, with additional inguinal node metastases in 1 and additional lung metastases in 1; 2 patients had only lung metastases. Six of the 7 patients with a relapse were given chemotherapy (PVB); 1 patient refused chemotherapy. In view of residual disease a surgical excision was performed; it revealed necrosis as well as mature teratoma. All 33 patients are still alive, the post-orchidectomy follow-up period being 12-38 months.

The clinical course of IgA nephropathy in adults.

Renal function was studied in 25 patients with IgA nephropathy, aged 15--48 years, during a mean follow-up period of 47 months. GFR remained normal in ten patients but decreased in 15, necessitating regular hemodialysis in five. The evolution of GFR was not related to the degree of increase of the serum IgA level or to the presence of recurrent respiratory tract infections. The mean age of the patients with decreased GFR was ten years older and the mean follow-up time 20 months longer than of patients with maintained renal function. Also these patients had more proteinuria and were more frequently hypertensive. Their initial renal biopsies showed histologic evidence of nephron loss. The hypothesis is discussed that IgA nephropathy in adults not infrequently follows a slowly progressive course.

Reliability analysis of first and second generation PSA assays.

PURPOSE: To assess the reliability of first and second generation PSA assays. MATERIALS AND METHODS: In the present investigation we sought to compare pretreatment serum PSA levels determined by a first (IMx) and a second (IMMULITE) generation PSA assays to determine whether there were differences. Sera from 545 men were investigated in the range > 0 - 5330 microg/L, and prostatic histology was known, based on either transrectal ultrasound (TRUS), guided systematic needle biopsies, or transurethral resection or prostatectomy. RESULTS: Over the entire range there was an excellent correlation (r > 0.97) between the IMx and the IMMULITE PSA assays. When analyzed according to histology, there was an equivalent slope in the PSA ranges for patients with benign prostatic hyperplasia compared with prostate cancer patients. The area under the ROC curve for the IMx for the total PSA range was 0.7860, and for the IMMULITE assay the area under the ROC curve was 0.7810, a striking resemblance and not different significantly (p=0.87). CONCLUSION: For the majority of men, the first (IMx) and second (IMMULITE) generation PSA assays are equivalent. Small differences between both assays will not be of clinical significance for most men, but should be considered when comparing results of different assays in sequential determinations for a specific man.

Proteolytic activity at neutral pH in bovine spleen.

Proteolytic activity at neutral pH can be demonstrated in extracts from beef spleen. This activity is completely due to an aminopeptidase - or a number of aminopeptides - which is able to hydrolyse proteins completely to amino acids. No evidence was found for the presence of endopeptidases active at neutral pH. The enzyme resembles to some extent swine kidney aminopeptides.