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Biomarkers of disease recurrence in stage I testicular germ cell tumours

Nature Reviews Urology volume 19, pages 637–658 (2022)Cite this article

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Abstract

Stage I testicular cancer is a disease restricted to the testicle. After orchiectomy, patients are considered to be without disease; however, the tumour is prone to relapse in ~4–50% of patients. Current predictive markers of relapse, which are tumour size and invasion to rete testis (in seminoma) or lymphovascular invasion (in non-seminoma), have limited clinical utility and are unable to correctly predict relapse in a substantial proportion of patients. Adjuvant therapeutic strategies based on available biomarkers can lead to overtreatment of 50–85% of patients. Discovery and implementation of novel biomarkers into treatment decision making will help to reduce the burden of adjuvant treatments and improve patient selection for adjuvant therapy.

Key points

  • Relapse in clinical stage I germ cell tumour (CSI GCT) occurs in ~4–50% of patients after orchiectomy.

  • Currently available adjuvant treatment approaches to GCT lead to overtreatment in >50% of patients depending on the histology subtype as well as on the prevalence of risk factors.

  • Current predictive factors of relapse are lymphovascular invasion (for patients with non-seminoma GCT) and rete testis invasion and primary tumour size (for patients with seminoma GCT); however, these markers have a limited role in treatment decision making.

  • MicroRNA 371a-3p is a new diagnostic biomarker that showed the ability to detect tumour relapse earlier than radiological methods and could, therefore, be used to diagnose micrometastatic disease.

  • New biomarkers are urgently needed to improve patient stratification and reduce overtreatment.

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Fig. 1: Experimental biomarkers in stage I germ cell tumour.

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Acknowledgements

We would like to acknowledge Prof. James M. Reuben for English editing and thoughtful discussion. This work was supported by the Slovak Research and Development Agency (grant APVV-20-0158 and APVV-19-0411) and Comenius University (UK/195/2021). The sponsors had no direct role in the study.

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  1. 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia

    Peter Lesko, Michal Chovanec & Michal Mego

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P.L. researched data for the article. M.M. and M.C. contributed substantially to discussion of the content. P.L. wrote the article. M.M. and M.C. reviewed and edited the manuscript before submission.

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Lesko, P., Chovanec, M. & Mego, M. Biomarkers of disease recurrence in stage I testicular germ cell tumours. Nat Rev Urol 19, 637–658 (2022). https://doi.org/10.1038/s41585-022-00624-y

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