Survival from testicular cancer in England and Wales up to 2001

miR-21, miR-29a, and miR-106b: serum and tissue biomarkers with diagnostic potential in metastatic testicular cancer

The imperative need for sensitive and precise tools is underscored in cancer diagnostics, with biomarkers playing a pivotal role in facilitating early detection and tumor diagnosis. Despite their classical pathological classification, testicular tumors lack valuable markers, emphasizing the necessity to identify and apply serum tumor markers in clinical management. Unfortunately, existing biomarkers exhibit limited sensitivities and specificities. Recent years have witnessed the discovery of novel RNA molecules, presenting a potential breakthrough as diagnostic tools and promising biomarkers. This report presents compelling evidence supporting the detection of early testicular cancer by applying a set of nine microRNAs (miRNAs), establishing them as valuable serum biomarkers for diagnosis. We developed a standardized serum-based measurement protocol and conducted comprehensive statistical analyses on the dataset to underscore the diagnostic accuracy of the miRNA pool. Notably, with a sensitivity exceeding 93%, miR-21, miR-29a, and miR-106b surpass classical serum tumor markers in the context of testicular cancer. Specifically, these miRNAs are poised to enhance clinical decision-making in testicular cancer detection and hold the potential for assessing tumor growth in monitoring chemotherapy outcomes.

Urological second malignant neoplasms in testicular nonseminoma survivors: a population-based analysis

PURPOSE

Patients with testicular non-seminomatous germ cell tumors in the modern cisplatin-based chemotherapy era show favorable outcomes, yielding survivors exposed to increased risk of second malignant neoplasms. The carcinogenic effects of cisplatin were well established, and its side effects had shown close connections with the urinary system. The study aimed to evaluate how the characteristics of the primary testicular nonseminoma are associated with urological second malignant neoplasms and survival outcomes.

METHODS

Using the Surveillance, Epidemiology and End Results database, standardized incidence ratios (SIR) for three major urological tumors including kidney, bladder, and prostate cancer were calculated for 10,734 patients with testicular nonseminoma from 1975 to 2016. The survival analyses were performed using the Kaplan-Meier method and log-rank test, risk factors for overall survival were determined by Cox regression.

RESULTS

We identified a total of 197 patients with secondary urological neoplasms. Patients with previous testicular nonseminoma had elevated risk of kidney cancer (SIR 2.13, 95% CI 1.59-2.79), bladder cancer (SIR 1.47, 95% CI 1.07-1.59), and decreased risks of prostate cancer (SIR 0.75, 95% CI 0.61-0.91) compared with the general population. Patients diagnosed with testicular nonseminoma had favorable prognosis with 10-year overall survival reaching 91.8%, and patients with urological second malignant neoplasms showed better prognoses than patients with other second malignant neoplasms (log-rank P < 0.001).

CONCLUSION

Testicular nonseminoma survivors showed higher risks of kidney and bladder cancer associated with chemotherapy and decreased risk of prostate cancer. The prognosis of urological second neoplasms was better than other tumor origins.

Defining a New Prognostic Index for Stage I Nonseminomatous Germ Cell Tumors Using CXCL12 Expression and Proportion of Embryonal Carcinoma

PURPOSE

Up to 50% of patients diagnosed with stage I nonseminomatous germ cell tumors (NSGCTs) harbor occult metastases. Patients are managed by surveillance with chemotherapy at relapse or adjuvant treatment up front. Late toxicities from chemotherapy are increasingly recognized. Based on a potential biologic role in germ cells/tumors and pilot data, our aim was to evaluate tumor expression of the chemokine CXCL12 alongside previously proposed markers as clinically useful biomarkers of relapse.

EXPERIMENTAL DESIGN

Immunohistochemistry for tumor expression of CXCL12 was assessed as a biomarker of relapse alongside vascular invasion, histology (percentage embryonal carcinoma), and MIB1 staining for proliferation in formalin-fixed paraffin-embedded orchidectomy samples from patients enrolled in the Medical Research Council's TE08/22 prospective trials of surveillance in stage I NSGCTs.

RESULTS

TE08/TE22 trial patients had a 76.4% 2-year relapse-free rate, and both CXCL12 expression and percentage embryonal carcinoma provided prognostic value independently of vascular invasion (stratified log rank test P = 0.006 for both). There was no additional prognostic value for MIB1 staining. A model using CXCL12, percentage embryonal carcinoma, and VI defines three prognostic groups that were independently validated.

CONCLUSIONS

CXCL12 and percentage embryonal carcinoma both stratify patients' relapse risk over and above vascular invasion alone. This is anticipated to improve the stratification of patients and identify high-risk cases to be considered for adjuvant therapy.

[Testis cancer: the UK as a model]

Over the course of the past 30 years progress in identification of risk factors, improvements in therapy regimens and advances in treatment delivery have all served to render testis cancer a treatable and survivable malignancy. Institution of specialised oncology centres in the UK to address treatment options for urological cancers has proven to be an effective approach to managing testis cancer by drawing on interdisciplinary expertise and applying insights gained from ongoing R&D. This strategy could become a model for treating other cancers as well.