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精巣腫瘍の診断・管理にはヒト絨毛性ゴナドトロピンβ分画(以下βhCG)が有用といわれるが,日本では多くの場合遊離β分画を測定している。一方,現在hCGの多くは黄体化ホルモン(以下LH)との交差性がほとんどなく測定可能である。われわれは過去10年で経験した精巣腫瘍患者25例[seminomatous germ cell tumor(以下SGCT)4例,(non-seminomatous germ cell tumor(以下NSGCT)21例]に対して,hCGおよびβhCGを同時に測定し,有用性を検討した。感度はSGCTでhCG 3/4(75%),βhCG4/4(100%),NSGCTではhCG 20/21(95.2%)とβhCG 19/21(90.5%)であった。両者はNSGCTでのみ強い相関を認めた(相関係数r=0.95(p<0.001))。マーカー再発は3例7回であり,4回はhCG先行,3回は同時であった。SGCTではβhCGが有用だが,NSGCTでは治療効果,再発に関してhCGが高感度であり,精巣腫瘍の管理では可能な限り両マーカーを同時測定することが望ましいと思われた。
The use of serum human chorionic gonadotropin β-subunit(βhCG)as a specific marker of testicular cancer is controversial. Recently,a monoclonal immunoradiometric assay for hCG showed no cross-reactivity with luteinizing hormone. Twenty-five patients with testicular cancer(four with seminomatous germ cell tumors[SGCTs]and twenty-one with non-seminomatous germ cell tumors[NSGCTs])who were referred to our hospital over the last 10 years were assessed using serum hCG and βhCG assays. Serum hCG and βhCG were detected in 75% and 100% of the patients with SGCTs and in 95.2% and 90.5% of the patients with NSGCTs,respectively. Thus,the serum hCG and βhCG levels were highly correlated(r=0.90,p<0.001)in patients with NSGCTs,but not correlated in the patients with SGCTs. Three patients with NSGCTs exhibited marker recurrences seven times in total and only hCG was elevated in four of these instances,while hCG and βhCG were simultaneously elevated in the remaining three instances. These results suggested that βhCG is more useful as a marker of SGCT,while hCG is more useful as a marker of NSGCT. Simultaneous determination of both markers may be more helpful for the management of testicular cancer.
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