Journal of Experimental & Clinical Cancer Research Research BioMed Central Open Access Serum human chorionic gonadotropin is associated with angiogenesis in germ cell testicular tumors Oscar Arrieta*1,2,3, Rosa Mayela Michel Ortega†1,2, Julián Ángeles-Sánchez†4, Cynthia Villarreal-Garza†3,5, Alejandro Avilés-Salas†6, José G Chanona-Vilchis†6, Elena Aréchaga-Ocampo†2, Arturo Luévano-González†6, Miguel Ángel Jiménez†7 and José Luis Aguilar†1 Address: 1Department of Medical Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico, 2Experimental Oncology Laboratory, Instituto Nacional de Cancerología, Mexico City, Mexico, 3Universidad Nacional Autónoma de México, Mexico City, Mexico, 4Division of Surgical Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico, 5Department of Medical Oncology, Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico, 6Department of Pathology, Instituto Nacional de Cancerología, Mexico City, Mexico and 7Division of Urology, Instituto Nacional de Cancerología, Mexico City, Mexico Email: Oscar Arrieta* - ogar@servidor.unam.mx; Rosa Mayela Michel Ortega - mayela_michel@yahoo.com.mx; Julián Ángeles- Sánchez - asjaqx@yahoo.com.mx; Cynthia Villarreal-Garza - cynthiavg@gmail.com; Alejandro Avilés-Salas - alejandroaviles2001@yahoo.com; José G Chanona-Vilchis - jgchanonav@yahoo.com; Elena Aréchaga-Ocampo - arechaga_ocampo@yahoo.com.mx; Arturo Luévano- González - aluevano81@yahoo.com; Miguel Ángel Jiménez - drmajr@prodigy.net.mx; José Luis Aguilar - oncoincan@hotmail.com * Corresponding author †Equal contributors Published: 27 August 2009 Journal of Experimental & Clinical Cancer Research 2009, 28:120 doi:10.1186/1756-9966-28-120 This article is available from: http://www.jeccr.com/content/28/1/120 Received: 8 July 2009 Accepted: 27 August 2009 © 2009 Arrieta et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Germ cell testicular tumors have survival rate that diminishes with high tumor marker levels, such as human chorionic gonadotropin (hCG). hCG may regulate vascular neoformation through vascular endothelial growth factor (VEGF). Our purpose was to determine the relationship between hCG serum levels, angiogenesis, and VEGF expression in germ cell testicular tumors. Methods: 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. Results: 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. Conclusion: 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. Page 1 of 7 (page number not for citation purposes)