A 10-year retrospective single-center study of alpha-fetoprotein and beta-human chorionic gonadotropin in Romanian children with (para)gonadal tumors and cysts

Usiwoma O. Ataikiru; Emil R. Iacob; Ingrith Miron; Calin M. Popoiu; Eugen S. Boia

doi:10.1515/jpem-2021-0382

Article

A 10-year retrospective single-center study of alpha-fetoprotein and beta-human chorionic gonadotropin in Romanian children with (para)gonadal tumors and cysts

Usiwoma O. Ataikiru , Emil R. Iacob , Ingrith Miron , Calin M. Popoiu and Eugen S. Boia

Published/Copyright: December 29, 2021

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 35 Issue 3

Abstract

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 (β-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 β-hCG in 134 children with cysts and (para)gonadal tumors aged one month to 17 years was performed.

Results

AFP/β-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/β-hCG, 3/48 patients had recurrences, and 25/48 had mixed-GCT (68% had elevated AFP + β-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 + β-hCG- 0.828, 67.2%, 100%; AFP- 0.813, 64.1%, 100%; and β-hCG- 0.664, 32.8%, 100%. Two patients whose AFP/β-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/β-hCG.

Conclusions

AFP/β-hCG detects malignant GCT and can determine tumor-type. GCT patients with markedly elevated AFP + β-hCG had poor prognosis, especially if recurrence or metastasis was present. Recurrence is unrelated to elevated AFP/β-hCG. The tumor components and quantity present determine AFP/β-hCG values in mixed-GCT.

Keywords: alpha-fetoprotein; beta-human chorionic gonadotropin; children; germ cell tumor; ovarian tumor; testicular tumor

Corresponding author: Dr. Usiwoma O. Ataikiru, MD, Department of Pediatric Surgery and Orthopedics, “Louis Turcanu” Emergency Childrens Hospital. No. 2, Dr. Iosif Nemoianu Street, Timisoara 300011, Romania; and Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania, Phone: +40 725435697, E-mail: usiwomaataikiru@yahoo.com

All authors contributed significantly to this work.

Acknowledgments

We thank the statistician, Mr. Jeremiah Oyedemi for assisting in the statistical analysis.

Research funding: None declared.
Author contributions: Ingrith Miron, Calin M Popoiu, and Eugen S Boia conceptualized the study, its design, supervised, and revised the article. Usiwoma O Ataikiru and Emil R Iacob compiled, analyzed, and interpreted the data for the article, and also wrote the draft of the article, including literature search. Usiwoma O Ataikiru is the guarantor of the article. All authors are responsible for the accuracy of the data and approved the final version of the article. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed and written consent was obtained from the parents of all children included in this study.
Ethical approval: This study has complied with all relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration and was approved by the Ethics committee of the ‘Louis Turcanu’ Emergency Children’s Clinical Hospital Timisoara (No. 122/2020-16923 on 11.12.2020).

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Received: 2021-06-05

Accepted: 2021-12-06

Published Online: 2021-12-29

Published in Print: 2022-03-28

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https://doi.org/10.1515/jpem-2021-0382

Keywords for this article

alpha-fetoprotein; beta-human chorionic gonadotropin; children; germ cell tumor; ovarian tumor; testicular tumor