Fero KE, Lec PM, Sharma V, et al. - In patients with pure seminomatous testicular germ cell tumors (GCT), the detection of elevated serum alpha-fetoprotein (AFP) is a discordant finding that suggests the presence of occult non-seminomatous GCT (NSGCT) elements. 8% of patients with pure seminomatous GCTs had diagnostically discordant elevated pre-operative AFP levels. Patients with seminoma and elevated AFP were managed in a fashion comparable to those with seminoma and normal AFP levels, despite recommendations to manage these patients as NSGCT.

• Among 18,616 individuals diagnosed with testicular GCT, 53% (N=9,849) had pure seminomatous histology, of whom 8.3% (N=821) had an elevated serum AFP pre-operatively.

• The data showed that non-white patients with seminoma were more likely to have a pre-op elevated AFP (OR 1.42; 95% CI: 1.10–1.83); patients treated at higher volume centers were less likely to have a pre-op elevated AFP (0.66, 95% CI: 0.53–0.83).

• It was shown that patients with seminoma with increased AFP received adjuvant radiation more frequently in comparison with those with NSGCT (Stage I: 15% vs 0.2%, p < 0.01; Stage II: 21.9% vs 0.1%, p <0.01) and less frequently had undergone retroperitoneal lymph node dissection (Stage 1: 1.9% vs 11.1% p <0.01; Stage II: 8.8% vs 17.4%, p <0.01).