Real-World Application of Pre-Orchiectomy miR-371a-3p Test in Testicular Germ Cell Tumor Management.

Abstract

PURPOSE:

Current serum tumor markers for testicular germ cell tumor are limited by low sensitivity. Growing evidence supports the use of circulating miR-371a-3p as a superior marker for malignant (viable) germ cell tumor management. We evaluated the real-world application of serum miR-371a-3p levels in detecting viable germ cell tumor among patients undergoing partial or radical orchiectomy.

MATERIALS AND METHODS:

Serum samples were collected from 69 consecutive patients before orchiectomy. Performance characteristics of serum miR-371a-3p were compared with conventional serum tumor markers (⍺-fetoprotein/β-human chorionic gonadotropin/lactate dehydrogenase) between patients with viable germ cell tumor and those without viable germ cell tumor on orchiectomy pathology. Relative miR-371a-3p levels were correlated with clinical course. The Kruskal-Wallis test and linear and ordinal regression models were used for analysis.

RESULTS:

For detecting viable germ cell tumor, combined conventional serum tumor markers had a specificity of 100%, sensitivity of 58% and AUC of 0.79. The miR-371a-3p test showed a specificity of 100%, sensitivity of 93% and AUC of 0.978. Median relative expression of miR-371a-3p in viable germ cell tumor cases was more than 6,800-fold higher than in those lacking viable germ cell tumor. miR-371a-3p levels correlated with composite stage (p=0.006) and, among composite stage I cases, independently associated with embryonal carcinoma percentage (p=0.0012) and tumor diameter (p <0.0001). Six patients underwent orchiectomy after chemotherapy and were correctly predicted to have presence or absence of viable germ cell tumor by the miR-371a-3p test.

CONCLUSIONS:

If validated, the miR-371a-3p test can be used in conjunction with conventional serum tumor markers to aid clinical decision making. A positive miR-371a-3p test in patients after preoperative chemotherapy or with solitary testes could potentially guide subsequent orchiectomy or observation.

• Authors: Rohit R Badia, Dreaux Abe, Daniel Wong, Nirmish Singla, Anna Savelyeva, Nathan Chertack, Solomon L Woldu, Yair Lotan, Ryan Mauck, Dan Ouyang, Xiaosong Meng, Cheryl M Lewis, Kuntal Majmudar, Liwei Jia, Payal Kapur, Lin Xu, A Lindsay Frazier, Vitaly Margulis, Douglas W Strand, Nicholas Coleman, Matthew J Murray, James F Amatruda, John T Lafin, Aditya Bagrodia
• Journal: The Journal of urology (J Urol) Vol. 205 Issue 1 Pg. 137-144 (Jan 2021) ISSN: 1527-3792 [Electronic] United States
• PMID: 32856980 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• Circulating MicroRNA
• MIRN371 microRNA, human
• MicroRNAs

Topics

• Adult
• Biomarkers, Tumor (blood)
• Case-Control Studies
• Chemotherapy, Adjuvant
• Circulating MicroRNA (blood)
• Clinical Decision-Making (methods)
• Feasibility Studies
• Humans
• Male
• MicroRNAs (blood)
• Middle Aged
• Neoadjuvant Therapy (methods)
• Neoplasm Staging
• Neoplasms, Germ Cell and Embryonal (blood, diagnosis, pathology, therapy)
• Orchiectomy
• Preoperative Period
• Testicular Neoplasms (blood, diagnosis, pathology, therapy)
• Testis (pathology, surgery)
• Watchful Waiting