Elevations of α-fetoprotein in patients undergoing chemotherapy for pure testicular seminoma: a retrospective cohort study

Background α-Fetoprotein (AFP) is conventionally absent in testicular classical seminoma (TCS). However, moderate AFP elevations can occur in TCS patients, as observed at this and other centres, which can be challenging to diagnostic and management practices.

Methods This retrospective cohort study considered AFP concentration in the context of germ-cell tumour diagnosis and characterisation at baseline (BL), disease status during chemotherapy, and long-term surveillance. The study considered patients with histologically diagnosed stage 1 TCS requiring chemotherapy over six years. For those with AFP above the reference interval at BL, histological imaging, case notes, and biochemical data were reviewed from BL to surveillance completion. Outcomes included AFP changes, diagnoses, therapy, disease progression, and death.

Results Of the 175 patients included, eight (4.6%) had elevated AFP at BL. Of these, two showed statistically but not clinically significant AFP changes during therapy, while six had moderate, stable AFP elevations with no changes in diagnosis during follow-up. During therapy, one patient developed metastases, and one died of causes likely unrelated to their TCS.

Conclusions Mild elevations of AFP in TCS may lead to diagnostic uncertainty or inappropriate management and investigation. However, AFP changes, alongside imaging, did not affect diagnosis, therapy, or follow-up at this centre for any of the patients examined. A subgroup of TCS patients has stable, moderate AFP elevations unrelated to tumour aetiology.