Different hCG assays to measure ectopic hCG secretion in bladder carcinoma patients

We evaluated the clinical performance of assays measuring intact human chorionic gonadotropin alone (i-hCG), intact and nicked human chorionic gonadotropin (i-hCG and hCGn), free beta-subunit (free beta-hCG) and total beta-human chorionic gonadotropin (t-hCG) using different commercial kits, in a group of bladder carcinoma patients with ectopic human chorionic gonadotropin (hCG) secretion, at diagnosis and during treatment. The diagnostic sensitivity obtained ranged between 63.6% and 75.7% (t-hCG assays), 72.7% (free beta-hCG assay), 18.2% (i-hCG and hCGn) and 6% (i-hCG assay). Median increases of hCG during treatment in patients with chemotherapy resistance ranged from 4.9 to 6.9 for t-hCG and free beta-hCG assays and from 1.4 to 3.2 for i-hCG and i-hCG plus hCGn assays. Median decreases when chemotherapy was efficient ranged from 2.8 to 3.3 (t-hCG and free beta-hCG assays) and from 1.1 to 1.5 (i-hCG and i-hCG plus hCGn assays). We conclude that t-hCG and free beta-hCG are the most suitable assays for the management of bladder carcinoma patients as the ectopic secretion of chorionic gonadotropin is mainly due to the free beta-subunit.