Matulewicz Richard S, Fankhauser Christian D, Sheinfeld Joel, Bagrodia Aditya
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
University of Zurich, Zurich, Switzerland.
Transl Androl Urol. 2023 Jun 30;12(6):1016-1022. doi: 10.21037/tau-22-855. Epub 2023 May 24.
Surveillance is the preferred management strategy for most men with clinical stage I testicular cancer after orchiectomy. However, frequent office visits, imaging tests, and laboratory studies place a significant burden on patients, which may contribute to poor compliance with guideline-recommended surveillance regimens. Identifying strategies to overcome these barriers may help improve quality of life, reduce costs, and improve adherence for patients. We reviewed evidence for three strategies that may help with surveillance redesign: telemedicine, implementing microRNA (miRNA) as a biomarker, and novel imaging protocols.
A web-based literature search for novel imaging strategies, diagnostic utility of miRNA, and telehealth as they relate to early-stage testicular germ cell cancer was completed during the month of August 2022. We focused our search on contemporary PubMed-indexed and Google Scholar-registered manuscripts written in English. Supportive data sourced from current guideline statements were also included. Evidence was compiled for narrative review.
Telemedicine is a safe and acceptable platform for urologic cancer follow-up care, but it requires further study specifically among men with testicular cancer. Access to care may either be improved or reduced depending on system- and patient-level characteristics and should be implemented with this in mind. miRNA may potentially be a helpful biomarker for men with localized disease, but further research on diagnostic accuracy and marker kinetics are needed before implementing it into routine surveillance strategies or using it to deviate from long-standing surveillance regiments. Novel imaging strategies with less frequent imaging and the use of magnetic resonance imaging (MRI) instead of computed tomography (CT) appear to be non-inferior in clinical trials. However, use of MRI requires expert radiologist availability and may be more costly with a lower ability to detect small, early recurrences when used in routine practice.
Using telemedicine, integrating miRNA as a tumor marker, and adopting less intensive imaging strategies may improve guideline-concordant surveillance for men with localized testicular cancer. Future studies are needed to assess the risks and benefits of using these novel approaches separately or together.
对于大多数临床I期睾丸癌患者，睾丸切除术后监测是首选的管理策略。然而，频繁的门诊就诊、影像学检查和实验室研究给患者带来了巨大负担，这可能导致患者对指南推荐的监测方案依从性差。确定克服这些障碍的策略可能有助于提高生活质量、降低成本并提高患者的依从性。我们回顾了三种可能有助于重新设计监测方案的策略的证据：远程医疗、将微小RNA（miRNA）作为生物标志物以及新型成像方案。
2022年8月，我们完成了一项基于网络的文献检索，内容涉及与早期睾丸生殖细胞癌相关的新型成像策略、miRNA的诊断效用以及远程医疗。我们的检索重点是当代发表在PubMed索引和谷歌学术注册的英文手稿。还纳入了来自当前指南声明的支持性数据。收集证据进行叙述性综述。
远程医疗是泌尿外科癌症后续护理的一个安全且可接受的平台，但需要在睾丸癌男性患者中进行进一步专门研究。根据系统和患者层面的特征，获得医疗服务的情况可能会改善或减少，实施时应考虑到这一点。miRNA可能对局限性疾病的男性患者是一种有用的生物标志物，但在将其纳入常规监测策略或用于偏离长期监测方案之前，需要对诊断准确性和标志物动力学进行进一步研究。在临床试验中，成像频率较低且使用磁共振成像（MRI）而非计算机断层扫描（CT）的新型成像策略似乎并不逊色。然而，使用MRI需要有专业放射科医生，并且在常规实践中使用时可能成本更高，检测小的早期复发的能力较低。
使用远程医疗、将miRNA整合为肿瘤标志物以及采用强度较低的成像策略可能会改善局限性睾丸癌男性患者符合指南的监测。需要进一步研究来评估单独或联合使用这些新方法的风险和益处。
