Abnormal levels of serum lactic dehydrogenase-1 (LD-1) activity have been observed in 81% (34/42) of patients with stage III germ cell malignancy of the testis. The criteria for evaluation the electrophoretic isoenzyme patterns of these patients were, as follows: For criterion 1 elevations the LD-1 value in absolute units was greater than 52.0 U/I with the LD-1/Total LD ratio greater than 37.2%. Criterion 2 elevations had absolute values of LD-1 less than 52.0 U/I, but the LD-1/Total LD ratio was greater than 37.2%. For criterion 3 elevations of LD-1, the absolute value was greater than 52 U/I and the LD-1/Total LD ratio was less than 37.2% activity with the LD-5/LD-1 ratio less than 0.5; or when the LD-5/LD-1 ratio was greater than 0.5 but the LD-1 is equal to or greater than the LD-2. The frequency of LD-1 elevation correlated well with the extent of the disease (stage II-B-1 and 2, 50%; stage III-B-3, 86%; stage III-B-4, 91%; stage III-B-5, 93%). LD-1 elevation occurred in groups I, II, IV and V histopathologic cell types (Dixon and Moore Classification) and there did not appear to be any correlation between the histologic cell type and the frequency of elevation of LD-1. Interpretation of LD-1 activity only on the basis of its relative ratio to the total LD value (criterion 1 and 2) identified a total of 28 patients (67%). A criterion 3 elevation was demonstrated in 6 (14%) additional patients. All patients with persistent elevations or recurrent elevations of LD-1 have shown progressive or recurrent disease and patients with no clinical evidence of disease have demonstrated normal LD-1 values. In those patients with elevated LD-1 activity, serial measurements of serum. LD-1 isoenzyme reflect the response of the patient to therapy.
[Show abstract][Hide abstract] ABSTRACT: A retrospective study was undertaken to determine the prognostic significance of endodermal sinus tumor (EST) elements in 56 patients with Stage III nonseminatous germ cell tumors of the testes (NSGCTT). The study patients were treated with conventional vinblastine, bleomycin and cisplatinum chemotherapy prior to our recognition of EST as a distinct entity. Twenty-one (37.5%) of the patients had EST elements in their tumors. Nineteen patients had EST in their primary testis tumor, whereas two had EST in metastatic sites only. Prognostic criteria (tumor volume, Dixon-Moore classification and chemotherapy vinblastin and bleomycin [VB] and VB plus cisplatin [VB + P] ) were similar in EST and non-EST patients. Long-term disease-free survival was significantly poorer for patients with Stage III NSGCTT containing EST (38%) compared with those not containing EST (71%) (P = 0.04). All 12 patients with small volume disease (III-B1-III-B2), independent of the presence of EST, are alive and free of disease for more than 2 years. Only 6 of 18 patients (33%) with advanced disease and EST are alive and free of disease, whereas 17 of 26 (65%) of patients with advanced disease not containing EST are alive and free of disease (P = 0.074). The addition of single agent bolus cisplatin to the treatment of patients with advanced disease achieved no improvement in survival. Endodermal sinus tumor must be included in future studies of advanced Stage III NSGCTT as an important prognostic variable.
Cancer 02/1984; 53(1):122-8. DOI:10.1002/1097-0142(19840101)53:1<122::AID-CNCR2820530122>3.0.CO;2-B · 4.89 Impact Factor
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