What is the marker with prognostic significance in cases of seminoma?

Serum Lactate Dehydrogenase (LDH) is the Marker with Prognostic Significance in Cases of Seminoma

The correct answer is (e) serum lactate dehydrogenase. LDH is the tumor marker with established prognostic significance in seminoma cases, particularly for patients with advanced disease.

Tumor Markers in Seminoma

LDH as a Prognostic Marker

• LDH is a critical serum tumor marker for determining prognosis in seminoma patients 1
• In advanced seminoma, elevated LDH levels greater than twice the upper limit of normal predict shorter progression-free survival (PFS) and overall survival (OS) 1
• A recent analysis by the Global Germ Cell Tumor Collaborative Group found that LDH levels ≥2.5 times the upper limit of normal were associated with significantly lower 5-year overall survival rates (83% vs 93%) compared to patients with lower LDH levels 2
• LDH is included in the International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic classification scheme for risk stratification 1

Other Markers and Their Limitations

Alpha-fetoprotein (AFP)

• AFP is never elevated in pure seminoma 1
• An elevated AFP in a patient with histologically "pure" seminoma indicates the presence of an undetected nonseminomatous component 1
• The presence of AFP would reclassify the tumor as a nonseminoma, not a pure seminoma 1

Human Chorionic Gonadotropin-β (β-HCG)

• While β-HCG may be elevated in some seminoma cases, it has limited prognostic significance 1, 3
• Elevated β-HCG does not affect the IGCCCG prognostic classification for seminoma patients 1
• β-HCG has high specificity (100%) but low sensitivity (32%) as a tumor marker in seminoma 3

Alkaline Phosphatase

• Alkaline phosphatase of hepatic origin is not recognized as a standard tumor marker for seminoma in clinical guidelines 1
• It is not included in the standard diagnostic or monitoring protocols for seminoma patients 1

Testosterone Level

• Testosterone level is not used as a prognostic marker in seminoma cases 1
• It may be measured as part of fertility assessment but has no established prognostic value 1

Clinical Application of LDH in Seminoma Management

Staging and Risk Stratification

• LDH is one of the three mandatory markers (along with AFP and β-HCG) that should be measured before and after orchiectomy 1
• LDH is particularly valuable in advanced metastatic seminoma, where it is elevated in up to 82% of cases 3
• The IGCCCG classification uses LDH levels as part of risk stratification for advanced germ cell tumors 1

Monitoring Treatment Response

• While LDH has prognostic value, guidelines recommend against using LDH alone to monitor treatment response in seminoma due to its high false-positive rate 1
• LDH should be interpreted cautiously during follow-up as false-positive elevations are common (7.7% of patient visits) 4

Limitations of LDH

• LDH has limited specificity (90.5%) and positive predictive value (12.8%) for detecting relapse 4
• False-positive LDH elevations occur in approximately 9.1% of patients during follow-up 4
• Recent research indicates that LDH alone does not independently contribute to early relapse detection in stage I seminoma 5

Practical Considerations

• When elevated LDH is detected during follow-up, consider repeat measurements to confirm the elevation and perform imaging studies to evaluate for possible relapse 4
• The combination of LDH with other markers (β-HCG) and imaging provides the most comprehensive approach to monitoring seminoma patients 1
• In patients with advanced seminoma, LDH levels should be considered when determining prognosis and treatment intensity 2