Serum human chorionic gonadotropin is associated with angiogenesis in germ cell testicular tumors

We conducted a retrospective study of 101 patients. Serum levels of hCG, alpha-fetoprotein (AFP), and lactate dehydrogenase were measured prior to surgery. Vascular density (VD) and VEGF tissue expression were determined by immunohistochemistry and underwent double-blind analysis.Histologically, 46% were seminomas and 54%, non-seminomas. Median follow-up was 43 ± 27 months. Relapse was present in 7.5% and mortality in 11.5%. Factors associated with high VD included non-seminoma type (p = 0.016), AFP ≥ 14.7 ng/mL (p = 0.0001), and hCG ≥ 25 mIU/mL (p = 0.0001). In multivariate analysis, the only significant VD-associated factor was hCG level (p = 0.04). When hCG levels were stratified, concentrations ≥ 25 mIU/mL were related with increased neovascularization (p < 0.0001). VEGF expression was not associated with VD or hCG serum levels.This is the first study that relates increased serum hCG levels with vascularization in testicular germ cell tumors. Hence, its expression might play a role in tumor angiogenesis, independent of VEGF expression, and may explain its association with poor prognosis. hCG might represent a molecular target for therapy.Testicular cancer is a clinically, epidemiologically, and histologically heterogeneous group of neoplasms that represents 1% of malignant tumors in males. Germ cell testicular cancer is the most common type of tumor in males between 15 and 40 years of age, comprising approximately 98% of all testicular cancers, with an annual incidence of 7.5 per 100,000 inhabitants [1-3]. Germ cell testicular tumors are classified into two major sub-groups based on histological findings: seminomas and non-seminomas, each comprising approximately 50% of cases.This malignancy possesses a high cure rate in its early and even in its metastatic stages, reaching 10-year survival rates between 90 and 100% [4,5]. However, there remains a sub-group of patients with poor prognosis with approximately 40% of 10-year mortality, regardless of treatment. In a