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Dieckmann KP, Grobelny F, Soave A, Che Y, Nestler T, Matthies C, Heinzelbecker J, Winter A, Heidenreich A, Niemzok T, Dumlupinar C, Angerer M, Wülfing C, Paffenholz P, Belge G. Serum Levels of MicroRNA-371a-3p for Predicting the Histology of Postchemotherapy Residual Masses of Germ Cell Tumours. Eur Urol Focus 2024:S2405-4569(24)00064-6. [PMID: 38729824 DOI: 10.1016/j.euf.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/08/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Serum levels of microRNA-371a-3p (M371) represent a novel and sensitive biomarker of germ cell tumours (GCTs). This study analysed the utility of M371 to identify viable cancer (VC) in postchemotherapy (pc) residual masses with the underlying goal of avoiding overtreatment. METHODS A multicentric, prospective diagnostic study was conducted in 180 GCT patients undergoing pc resection of residual masses. A correlation of M371 measurement results with the histological presence of VC in masses was found. A receiver operating characteristic analysis was performed for exploring the performance characteristics of the test. KEY FINDINGS AND LIMITATIONS The sensitivity was found to be 68.9%, specificity 99.3%, area under the curve 0.813, positive predictive value 0.969, and negative predictive value 0.905; sensitivity is significantly associated with the percentage of VC in the mass. In specimens with ≤10% VC, there were 33.3% elevated M371 levels as opposed to 85.7% in specimens with >50% VC. Teratoma and somatic-type malignancy do not express M371. A lack of a central pathological review is a limitation. CONCLUSIONS AND CLINICAL IMPLICATIONS The M371 test can identify 68.9% of patients with VC in pc masses. However, cases with <10% VC in the mass may escape detection. Teratoma does not express M371. The test alone cannot correctly identify patients requiring pc surgery, but it may be a tool for scheduling the extent of surgery. PATIENT SUMMARY The microRNA-371a-3p (M371) test can identify about two-thirds of patients with viable cancer in residual metastatic masses following chemotherapy for germ cell tumours. Only masses with high percentages of viable cancer cells can be identified, and the histological subtype teratoma remains undetected with the test.
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Affiliation(s)
| | - Francesca Grobelny
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany; Faculty of Medicine, University of Hamburg, Hamburg, Germany
| | - Armin Soave
- University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany
| | - Yue Che
- Department of Urology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Cord Matthies
- Department of Urology, Federal Armed Services Hospital, Hamburg, Germany
| | - Julia Heinzelbecker
- Department of Urology, Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Alexander Winter
- Department of Urology, University Hospital Oldenburg, Oldenburg, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Tabea Niemzok
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Cansu Dumlupinar
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Markus Angerer
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Pia Paffenholz
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Gazanfer Belge
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany.
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Belge G, Dumlupinar C, Nestler T, Klemke M, Törzsök P, Trenti E, Pichler R, Loidl W, Che Y, Hiester A, Matthies C, Pichler M, Paffenholz P, Kluth L, Wenzel M, Sommer J, Heinzelbecker J, Schriefer P, Winter A, Zengerling F, Kramer MW, Lengert M, Frey J, Heidenreich A, Wülfing C, Radtke A, Dieckmann KP. Detection of Recurrence through microRNA-371a-3p Serum Levels in a Follow-up of Stage I Testicular Germ Cell Tumors in the DRKS-00019223 Study. Clin Cancer Res 2024; 30:404-412. [PMID: 37967143 PMCID: PMC10792362 DOI: 10.1158/1078-0432.ccr-23-0730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/16/2023] [Accepted: 11/13/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE Surveillance of clinical stage I (CSI) testicular germ cell tumors (GCT) is hampered by low sensitivity and specificity of current biomarkers for detecting relapses. This study evaluated if serum levels of microRNA371a-3p (M371 test) can: (i) Accurately detect relapses, (ii) detect relapses earlier than conventional technology, and (iii) if elevated postoperative M371 levels may predict relapse. EXPERIMENTAL DESIGN In a multicentric setting, 258 patients with testicular CSI GCT were prospectively followed by surveillance for a median time of 18 months with serial measurements of serum M371 levels, in addition to standard diagnostic techniques. Diagnostic characteristics of M371 for detecting relapses were calculated using ROC curve analysis. RESULTS Thirty-nine patients recurred (15.1%), all with elevated M371 levels; eight without relapse had elevations, too. The test revealed the following characteristics: area under the ROC curve of 0.993, sensitivity 100%, specificity 96.3%, positive predictive value 83%, negative predictive value 100%. Earlier relapse detection with the test was found in 28%, with non-significant median time gain to diagnosis. Postoperative M371 levels did not predict future relapse. CONCLUSIONS The sensitivity and specificity of the M371 test for detecting relapses in CSI GCTs are much superior to those of conventional diagnostics. However, post-orchiectomy M371 levels are not predictive of relapse, and there is no significant earlier relapse detection with the test. In all, there is clear evidence for the utility of the M371 test for relapse detection suggesting it may soon be ready for implementation into routine follow-up schedules for patients with testicular GCT.
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Affiliation(s)
- Gazanfer Belge
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Cansu Dumlupinar
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Markus Klemke
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Peter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg University Hospital, Salzburg, Austria
| | | | - Renate Pichler
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Wolfgang Loidl
- Ordensklinikum Barmherzige Schwestern, Department Urology, Linz, Austria
| | - Yue Che
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Martin Pichler
- Research Unit of Non-Coding RNA, Division of Oncology, Medical University of Graz, Graz, Austria
| | - Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Luis Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jörg Sommer
- Department of Urology, St. Franziskus Krankenhaus Lohne, Lohne, Germany
| | - Julia Heinzelbecker
- Saarland University Medical Centre and Saarland University, Department of Urology, Homburg, Germany
| | | | - Alexander Winter
- Department of Urology, University Hospital Oldenburg, Oldenburg, Germany
| | | | - Mario Wolfgang Kramer
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marie Lengert
- Department of Tumor Genetics, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Jana Frey
- miRdetect GmbH, Bremerhaven, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
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Nestler T, Schoch J, Belge G, Dieckmann KP. MicroRNA-371a-3p-The Novel Serum Biomarker in Testicular Germ Cell Tumors. Cancers (Basel) 2023; 15:3944. [PMID: 37568759 PMCID: PMC10417034 DOI: 10.3390/cancers15153944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Testicular germ cell tumors (TGCTs) are a paradigm for the use of serum tumor markers in clinical management. However, conventional markers such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) have quite limited sensitivities and specificities. Within the last decade, the microRNA-371a-3p (miR371) emerged as a possible new biomarker with promising features. AREAS COVERED This review covers the typical features as well as possible clinical applications of miR371 in TGCT patients, such as initial diagnosis, therapy monitoring, and follow-up. Additionally, technical issues are discussed. EXPERT OPINION With a sensitivity of around 90% and specificity >90%, miR371 clearly outperforms the classical serum tumor markers in TGCTs. The unique features of the test involve the potential of modifying recent standards of care in TGCT. In particular, miR371 is expected to aid clinical decision-making in scenarios such as discriminating small testicular TGCT masses from benign ones prior to surgery, assessing equivocal lymphadenopathies, and monitoring chemotherapy results. Likewise, it is expected to make follow-up easier by reducing the intensity of examinations and by sparing imaging procedures. Overall, the data presently available are promising, but further prospective studies are required before the test can be implemented in standard clinical care.
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Affiliation(s)
- Tim Nestler
- Department of Urology, Federal Armed Forces Hospital Koblenz, 56072 Koblenz, Germany
| | - Justine Schoch
- Department of Urology, Federal Armed Forces Hospital Koblenz, 56072 Koblenz, Germany
| | - Gazanfer Belge
- Department of Tumour Genetics, University Bremen, 28359 Bremen, Germany
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Dieckmann KP, Dumlupinar C, Grobelny F, Utschig J, Klemke M, Ahmed Saad EM, Wülfing C, Pichlmeier U, Isbarn H, Belge G. Testicular neoplasms: the interrelationships of serum levels of microRNA-371a-3p (M371) and classical tumor markers with histology, clinical staging, and age-a statistical analysis. J Cancer Res Clin Oncol 2023; 149:7079-7090. [PMID: 36869885 PMCID: PMC9985438 DOI: 10.1007/s00432-023-04664-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE In testicular neoplasms, the interrelationship of elevations of the novel serum tumor marker microRNA-371a-3p (M371) and traditional markers with other clinical features is still incompletely understood. The present study evaluated marker expression rates in relation to various other clinical parameters. METHODS The following data were retrospectively registered from 641 consecutive patients with testicular neoplasms: histology, such as seminoma (n = 365), nonseminoma (n = 179), benign tumor (n = 79), other malignant tumor (n = 18); patients age (years); clinical stage (CS1, CS2a/b, CS2c, CS3); and preoperative elevation of beta HCG, AFP, LDH, M371 (yes/no). Descriptive statistical methods were employed with comparisons of various subgroups to disclose associations of marker expression rates with age, histology and CS, and of age with histology. RESULTS The histologic subgroups revealed significantly different expression rates of tumor markers. M371 performed best with expression rates of 82.69% and 93.58% in seminoma and in nonseminoma, respectively. In germ cell tumors, all markers had significantly higher expression rates in metastasized stages than in localized disease. All markers except LDH have significantly higher expression rates in younger than in older patients. Nonseminoma is most prevalent in the youngest age category, seminoma predominates in patients > 40 years, other malignancies were restricted to patients > 50 years. CONCLUSION The study documented significant associations of serum marker expression rates with histology, age and clinical staging, with highest rates in nonseminomas, young age and advanced clinical stages. M371 showed significantly higher expression rates than other markers suggesting its superior clinical usefulness.
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Affiliation(s)
| | - Cansu Dumlupinar
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | - Francesca Grobelny
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
- Faculty of Medicine, University of Hamburg, Hamburg, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Markus Klemke
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany
| | | | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Eppendorf, 20251, Hamburg, Germany
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, 20251, Hamburg, Germany
| | - Gazanfer Belge
- Department of Tumour Genetics, Faculty of Biology and Chemistry, University of Bremen, Leobener Strasse 2/FVG, 28359, Bremen, Germany.
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Constâncio V, Tavares NT, Henrique R, Jerónimo C, Lobo J. MiRNA biomarkers in cancers of the male reproductive system: are we approaching clinical application? Andrology 2022; 11:651-667. [PMID: 35930290 DOI: 10.1111/andr.13258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Specific cancer types face specific clinical management challenges. Owing to their stability, robustness and fast, easy, and cost-effective detection, microRNAs (miRNAs) are attractive candidate biomarkers to the clinic. OBJECTIVES Based on a comprehensive review of the relevant literature in the field, we explore the potential of miRNAs as biomarkers to answer relevant clinical dilemmas inherent to cancers of the male reproductive tract (prostate (PCa), testis (TGCTs) and penis (PeCa)) and identify some of the challenges/limitations hampering their widely application. RESULTS AND DISCUSSION We conclude that the use of miRNAs as biomarkers is at different stages for these distinct cancer types. While for TGCTs, miRNA-371a-3p is universally accepted to fill in important clinicals gaps and is moving fast towards clinical implementation, for PCa almost no overlap of miRNAs exists between studies, denoting the absence of a consistent miRNA biomarker, and for PeCa the field of miRNAs has just recently started, with only a few studies attempting to explore their clinical usefulness. CONCLUSION Technological advances influencing miRNA detection and quantification will be instrumental to continue to move forward with implementation of miRNAs in the clinic as biomarkers for non-invasive diagnosis, risk stratification, treatment monitoring and follow-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vera Constâncio
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Doctoral Programme in Biomedical Sciences, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
| | - Nuno Tiago Tavares
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal
| | - Rui Henrique
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology, Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
| | - João Lobo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology, Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
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