Nappi Lucia, Nichols Craig, Kollmannsberger Christian
Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada.
Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.
Transl Androl Urol. 2021 Oct;10(10):4075-4084. doi: 10.21037/tau-20-1246.
Management of testicular germ cell tumor (GCT) patients is based on clinical determinants, mainly CT scan and serum tumor markers (alpha-fetoprotein, beta subunit of HCG and LDH). Treatment decisions are usually straightforward for patients with clear evidence of metastatic disease, confirmed either by imaging tests or by unequivocal elevated tumor markers. However, there are several clinical scenarios where the assessment of metastatic disease is complicated by the limited specificity of the current imaging tests and serum tumor markers. These include patients with clinical stage IIA GCT with negative tumor markers and patients with post-chemotherapy residual disease where, in absence of clear indicators of GCT, decision making and patient treatment allocation become challenging. Therefore, more accurate biomarkers are critical to reduce the risk of under-or over-treatment and to always deliver the most optimal therapy. The objectives of this narrative review are to review the available publications about micro-RNAs in GCT s and their potential clinical applications. Two clusters of micro-RNAs, miR-371a-3p and miR-302/367, specifically expressed by both seminoma and non-seminoma GCT and easily detectable in the peripheral blood, have demonstrated to be promising in this endeavor. Large prospective trials are ongoing to define the operating characteristics of these biomarkers and their clinical utility to improve GCT patient management and reduce the error rate deriving from clinical uncertainty, therefore reducing the risk of sub-optimal treatments.
睾丸生殖细胞肿瘤（GCT）患者的管理基于临床决定因素，主要是CT扫描和血清肿瘤标志物（甲胎蛋白、人绒毛膜促性腺激素β亚基和乳酸脱氢酶）。对于有明确转移疾病证据的患者，治疗决策通常很简单，这些证据可通过影像学检查或明确升高的肿瘤标志物得到证实。然而，在几种临床情况下，由于当前影像学检查和血清肿瘤标志物的特异性有限，转移疾病的评估变得复杂。这些情况包括临床IIA期GCT且肿瘤标志物阴性的患者，以及化疗后残留疾病的患者，在没有明确的GCT指标时，决策制定和患者治疗分配变得具有挑战性。因此，更准确的生物标志物对于降低治疗不足或过度治疗的风险以及始终提供最优化治疗至关重要。本叙述性综述的目的是回顾关于GCT中微小RNA及其潜在临床应用的现有出版物。微小RNA的两个簇，即miR-371a-3p和miR-302/367，在精原细胞瘤和非精原细胞瘤GCT中均有特异性表达，且在外周血中易于检测，已证明在这方面很有前景。正在进行大型前瞻性试验，以确定这些生物标志物的操作特征及其临床效用，以改善GCT患者的管理并降低因临床不确定性导致的错误率，从而降低次优治疗的风险。
