This study prospectively collected presurgical serum samples and clinicopathologic characteristics from consecutive chemotherapy-naïve GCT patients undergoing primary RPLND from 2016-2019. Serum miRNAs (-367-3p/-371a-3p/-372-3p/-373-3p/-375) were isolated and quantified, and RPLND histopathology was categorized as benign, viable GCT, or teratoma. Between these histological groups, miRNA levels were compared. Performance characteristics, including receiver operating characteristic (ROC) curves, assessed the discriminative ability of each miRNA signature to predict viable GCT.
There were 24 patients with stage I-II germ cell tumors (50% stage I, 50% stage II) that underwent RPLND, revealing viable GCT in 11 (46%) patients, teratoma in 3 (13%) patients, and benign pathology in 10 (42%) patients. miR-371a-3p was the most discriminatory serum miRNA for viable germ cell tumor, exhibiting ~13,000-fold increase in expression over teratoma or benign pathology:
On ROC analysis, miR-371a-3p had an AUC of 0.965, a sensitivity of 100% and specificity of 92%. The AUC for other serum miRNAs in predicting viable GCT were 0.874 (miR-367-3p), 0.846 (miR-372-3p), and 0.720 (miR-373-3p). However, these serum miRNAs were not predictive of pure teratoma. A summary of the findings are as follows:
Dr. Singla concluded with the following points from this study of miRNA in chemotherapy-naïve patients:
- Serum miRNAs, particularly miR-371a-3p, can accurately differentiate small-volume viable GCT from benign processes or teratoma in patients with negative serum tumor markers undergoing primary RPLND
- If validated, these data suggest a basis to implement precision medicine strategies in treating patients with early-stage GCT
- Work is ongoing in collecting post-RPLND serum specimens for analysis
Presented by: Nirmish Singla, MD, Assistant Instructor/Fellow, Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md, at the 20th Annual Meeting of the Society of Urologic Oncology (SUO), December 4 - 6, 2019, Washington, DC
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