1
|
Huntley C, Torr B, Sud A, Rowlands CF, Way R, Snape K, Hanson H, Swanton C, Broggio J, Lucassen A, McCartney M, Houlston RS, Hingorani AD, Jones ME, Turnbull C. Utility of polygenic risk scores in UK cancer screening: a modelling analysis. Lancet Oncol 2023; 24:658-668. [PMID: 37178708 DOI: 10.1016/s1470-2045(23)00156-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND It is proposed that, through restriction to individuals delineated as high risk, polygenic risk scores (PRSs) might enable more efficient targeting of existing cancer screening programmes and enable extension into new age ranges and disease types. To address this proposition, we present an overview of the performance of PRS tools (ie, models and sets of single nucleotide polymorphisms) alongside harms and benefits of PRS-stratified cancer screening for eight example cancers (breast, prostate, colorectal, pancreas, ovary, kidney, lung, and testicular cancer). METHODS For this modelling analysis, we used age-stratified cancer incidences for the UK population from the National Cancer Registration Dataset (2016-18) and published estimates of the area under the receiver operating characteristic curve for current, future, and optimised PRS for each of the eight cancer types. For each of five PRS-defined high-risk quantiles (ie, the top 50%, 20%, 10%, 5%, and 1%) and according to each of the three PRS tools (ie, current, future, and optimised) for the eight cancers, we calculated the relative proportion of cancers arising, the odds ratios of a cancer arising compared with the UK population average, and the lifetime cancer risk. We examined maximal attainable rates of cancer detection by age stratum from combining PRS-based stratification with cancer screening tools and modelled the maximal impact on cancer-specific survival of hypothetical new UK programmes of PRS-stratified screening. FINDINGS The PRS-defined high-risk quintile (20%) of the population was estimated to capture 37% of breast cancer cases, 46% of prostate cancer cases, 34% of colorectal cancer cases, 29% of pancreatic cancer cases, 26% of ovarian cancer cases, 22% of renal cancer cases, 26% of lung cancer cases, and 47% of testicular cancer cases. Extending UK screening programmes to a PRS-defined high-risk quintile including people aged 40-49 years for breast cancer, 50-59 years for colorectal cancer, and 60-69 years for prostate cancer has the potential to avert, respectively, a maximum of 102, 188, and 158 deaths annually. Unstratified screening of the full population aged 48-49 years for breast cancer, 58-59 years for colorectal cancer, and 68-69 years for prostate cancer would use equivalent resources and avert, respectively, an estimated maximum of 80, 155, and 95 deaths annually. These maximal modelled numbers will be substantially attenuated by incomplete population uptake of PRS profiling and cancer screening, interval cancers, non-European ancestry, and other factors. INTERPRETATION Under favourable assumptions, our modelling suggests modest potential efficiency gain in cancer case detection and deaths averted for hypothetical new PRS-stratified screening programmes for breast, prostate, and colorectal cancer. Restriction of screening to high-risk quantiles means many or most incident cancers will arise in those assigned as being low-risk. To quantify real-world clinical impact, costs, and harms, UK-specific cluster-randomised trials are required. FUNDING The Wellcome Trust.
Collapse
Affiliation(s)
- Catherine Huntley
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; National Cancer Registration and Analysis Service, National Health Service (NHS) England, London, UK
| | - Bethany Torr
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Haemato-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Charlie F Rowlands
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Rosalind Way
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Katie Snape
- St Georges University of London, London, UK; South West Thames Regional Genetics Service, St George's Hospital, London, UK
| | - Helen Hanson
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; South West Thames Regional Genetics Service, St George's Hospital, London, UK
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London, UK
| | - John Broggio
- National Cancer Registration and Analysis Service, National Health Service (NHS) England, London, UK
| | - Anneke Lucassen
- Wellcome Centre for Human Genetics and Centre for Personalised Medicine, University of Oxford, Oxford, UK
| | - Margaret McCartney
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, UK
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Aroon D Hingorani
- University College London British Heart Foundation Research Accelerator Centre, London, UK; Health Data Research UK, London, UK; National Institute of Health Research Biomedical Research Centre and Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK; National Cancer Registration and Analysis Service, National Health Service (NHS) England, London, UK; Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK.
| |
Collapse
|
2
|
Rajpert‐De Meyts E, Jørgensen N, Petersen JH, Almstrup K, Aksglaede L, Lauritsen J, Rørth M, Daugaard G, Skakkebæk NE. Optimized detection of germ cell neoplasia in situ in contralateral biopsy reduces the risk of second testis cancer. BJU Int 2022; 130:646-654. [PMID: 35575005 PMCID: PMC9796833 DOI: 10.1111/bju.15774] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate whether optimized and standardized diagnostic procedures would improve detection of germ cell neoplasia in situ (GCNIS) in the contralateral testis of patients with testicular germ cell tumour (TGCT) and decrease the rate of metachronous tumours, which in a nationwide Danish study was estimated to be 1.9%. PATIENTS AND METHODS This was a retrospective analysis of outcomes in 655 patients with TGCT who underwent contralateral biopsies (1996-2007) compared with those in 459 non-biopsied TGCT controls (1984-1988). The biopsies were performed using a standardized procedure with immunohistochemical GCNIS markers and assessed by experienced evaluators. Initial histopathology reports were reviewed, and pathology and survival data were retrieved from national Danish registers. In 604/608 patients diagnosed as GCNIS-negative (four were lost to follow-up), the cumulative incidence of metachronous TGCT was estimated in a competing risk setting using the Grey method. All cases of metachronous TGCT were re-examined using immunohistochemistry. RESULTS Germ cell neoplasia in situ was found in 47/655 biopsied patients (7.2%, 95% confidence interval [CI] 5.4-9.5%). During the follow-up period (median 17.3 years) five of the 604 GCNIS-negative patients developed a TGCT. In 1/5 false-negative biopsies, GCNIS was found on histological revision using immunohistochemistry and 2/5 biopsies were inadequate because of too small size. The estimated cumulative incidence rate of second tumour after 20 years of follow-up was 0.95% (95% CI 0.10%-1.8%) compared with 2.9% (95% CI 1.3%-4.4%) among the non-biopsied TGCT patients (P = 0.012). The estimates should be viewed with caution due to the small number of patients with metachronous TGCT. CONCLUSIONS Optimized diagnostic procedures improved the detection rate of GCNIS in patients with TGCT and minimized their risk of developing metachronous bilateral cancer. Urologists should be aware of the importance of careful tissue excision (to avoid mechanical compression) and the need of adequate biopsy size. Performing contralateral biopsies is beneficial for patients' care and should be offered as a part of their management.
Collapse
Affiliation(s)
- Ewa Rajpert‐De Meyts
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | - Niels Jørgensen
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | | | - Kristian Almstrup
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | - Lise Aksglaede
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| | - Jakob Lauritsen
- Department of OncologyCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | - Mikael Rørth
- Department of OncologyCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | - Gedske Daugaard
- Department of OncologyCopenhagen University HospitalRigshospitaletCopenhagenDenmark
| | - Niels E. Skakkebæk
- Department of Growth and ReproductionCopenhagen University HospitalRigshospitaletCopenhagen
| |
Collapse
|
3
|
Mørup N, Stakaitis R, Golubickaite I, Riera M, Dalgaard MD, Schierup MH, Jørgensen N, Daugaard G, Juul A, Almstrup K. Small RNAs in Seminal Plasma as Novel Biomarkers for Germ Cell Tumors. Cancers (Basel) 2021; 13:cancers13102346. [PMID: 34067956 PMCID: PMC8152278 DOI: 10.3390/cancers13102346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Testicular cancer is the most common cancer among young men. It is rarely diagnosed at early stages, being only detected with a highly invasive procedure that presents notable side-effects. Circulating small RNAs have recently been identified as testicular tumor markers, but are unable to diagnose testicular cancer at an early pre-invasive stage. So far, studies have been limited to microRNAs, with other small RNAs remaining unexplored as likely biomarkers. By sequencing all small RNAs in semen samples from men with different stages of testicular cancer and healthy men, we identify signatures predictive of cancer, even at an early stage. Thus, our study provides great potential for non-invasive early diagnosis of testicular cancer. Extensive biological variance in small RNA levels across samples, together with small sample sizes, limit the power to detect single small RNA markers. Hence, larger studies are needed to confirm our findings and deduce their full diagnostic capacity. Abstract Circulating miRNAs secreted by testicular germ cell tumors (TGCT) show great potential as novel non-invasive biomarkers for diagnosis of TGCT. Seminal plasma (SP) represents a biofluid closer to the primary site. Here, we investigate whether small RNAs in SP can be used to diagnose men with TGCTs or the precursor lesions, germ cell neoplasia in situ (GCNIS). Small RNAs isolated from SP from men with TGCTs (n = 18), GCNIS-only (n = 5), and controls (n = 25) were sequenced. SP from men with TGCT/GCNIS (n = 37) and controls (n = 22) were used for validation by RT-qPCR. In general, piRNAs were found at lower levels in SP from men with TGCTs. Ten small RNAs were found at significantly (q-value < 0.05) different levels in SP from men with TGCT/GCNIS than controls. Random forests classification identified sets of small RNAs that could detect either TGCT/GCNIS or GCNIS-only with an area under the curve of 0.98 and 1 in ROC analyses, respectively. RT-qPCR validated hsa-miR-6782-5p to be present at 2.3-fold lower levels (p = 0.02) in the SP from men with TGCTs compared with controls. Small RNAs in SP show potential as novel biomarkers for diagnosing men with TGCT/GCNIS but validation in larger cohorts is needed.
Collapse
Affiliation(s)
- Nina Mørup
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (N.M.); (R.S.); (I.G.); (N.J.); (A.J.)
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Rytis Stakaitis
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (N.M.); (R.S.); (I.G.); (N.J.); (A.J.)
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Laboratory of Molecular Neurooncology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Ieva Golubickaite
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (N.M.); (R.S.); (I.G.); (N.J.); (A.J.)
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Department of Genetics and Molecular Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Meritxell Riera
- Bioinformatics Research Centre, Aarhus University, 8000 Aarhus C, Denmark; (M.R.); (M.H.S.)
| | - Marlene Danner Dalgaard
- DTU Multi-Assay Core, Department of Health Technology, Technical University of Denmark, 2800 Lyngby, Denmark;
| | - Mikkel H. Schierup
- Bioinformatics Research Centre, Aarhus University, 8000 Aarhus C, Denmark; (M.R.); (M.H.S.)
| | - Niels Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (N.M.); (R.S.); (I.G.); (N.J.); (A.J.)
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (N.M.); (R.S.); (I.G.); (N.J.); (A.J.)
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kristian Almstrup
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (N.M.); (R.S.); (I.G.); (N.J.); (A.J.)
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-3545-6639
| |
Collapse
|
4
|
Application of miRNAs in the diagnosis and monitoring of testicular germ cell tumours. Nat Rev Urol 2020; 17:201-213. [PMID: 32157202 DOI: 10.1038/s41585-020-0296-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 02/08/2023]
Abstract
Testicular germ cell tumours (TGCTs) are the most frequent cancer type in young men and originate from the common precursor germ cell neoplasia in situ (GCNIS). For decades, clinical management of patients with TGCT has relied on classic serum tumour markers: α-fetoprotein, human chorionic gonadotropin subunit-β and lactate dehydrogenase. In the past 10 years, microRNAs have been shown to outperform classic serum tumour markers in the diagnosis of primary tumours and in follow-up monitoring and prediction of relapse. miR-371a-3p is the most consistent marker and exhibits >90% diagnostic sensitivity and specificity in TGCT. However, miR-371a-3p cannot be used to diagnose GCNIS or mature teratoma. Future efforts must technically standardize the microRNA-based methods internationally and introduce miR-371a-3p as a molecular liquid biopsy-based marker for TGCTs in the clinic.
Collapse
|
5
|
Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 192] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
Collapse
Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| |
Collapse
|
6
|
Aoun F, Slaoui A, Naoum E, Hassan T, Albisinni S, Azzo JM, Kallas-Chemaly A, Assenmacher G, Peltier A, Roumeguère T. Testicular microlithiasis: Systematic review and Clinical guidelines. Prog Urol 2019; 29:465-473. [DOI: 10.1016/j.purol.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/24/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022]
|
7
|
Radtke A, Cremers JF, Kliesch S, Riek S, Junker K, Mohamed SA, Anheuser P, Belge G, Dieckmann KP. Can germ cell neoplasia in situ be diagnosed by measuring serum levels of microRNA371a-3p? J Cancer Res Clin Oncol 2017; 143:2383-2392. [PMID: 28819887 PMCID: PMC5640733 DOI: 10.1007/s00432-017-2490-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/01/2017] [Indexed: 12/11/2022]
Abstract
Purpose Diagnosing germ cell neoplasia in situ (GCNis) can detect germ cell tumours (GCTs) at the pre-invasive stage. To date, testicular biopsy with the potential of surgical complications is the only way of safely diagnosing GCNis. Recently, microRNAs (miRs) 371-3, and miR 367 were shown to be valuable serum biomarkers of GCTs. We explored the usefulness of these candidate miRs as a marker for GCNis. Methods 27 patients with GCNis and no concomitant GCT were enrolled. All patients underwent measuring serum levels of miR-371a-3p and miR-367-3p before treatment, 11 had repeat measurement after treatment, 2 also had testicular vein blood examinations. Serum levels were measured by quantitative PCR. In addition, four orchiectomy specimens of patients with GCT were examined immunohistochemically and by in situ hybridization (ISH) with a probe specific for miR-371a-3p to look for the presence of this miR in GCNis cells. Results The median serum level of miR-371a-3p was significantly higher in patients with GCNis than in controls, miR-367 levels were not elevated. Overall, 14 patients (51.9%) had elevated serum levels of miR-371a-3p. The highest levels were found in patients with bilateral GCNis. Levels in testicular vein serum were elevated in both of the cases. After treatment, all elevated levels dropped to normal. In two orchiectomy specimens, miR-371a-3p was detected by ISH in GCNis cells. Conclusions Measuring miR-371a-3p serum levels can replace control biopsies after treatment of GCNis. In addition, the test can guide clinical decision making regarding the need of testicular biopsy in cases suspicious of GCNis.
Collapse
Affiliation(s)
- A Radtke
- Faculty of Biology and Chemistry, University of Bremen, Leobener Str. 2, 28359, Bremen, Germany.
| | - J-F Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Riek
- Faculty of Biology and Chemistry, University of Bremen, Leobener Str. 2, 28359, Bremen, Germany
| | - K Junker
- Department of Pathology, Klinikum Bremen-Mitte, Bremen, Germany
| | - S A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - P Anheuser
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
| | - G Belge
- Faculty of Biology and Chemistry, University of Bremen, Leobener Str. 2, 28359, Bremen, Germany
| | - K-P Dieckmann
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
| |
Collapse
|
8
|
The genomic landscape of testicular germ cell tumours: from susceptibility to treatment. Nat Rev Urol 2016; 13:409-19. [PMID: 27296647 DOI: 10.1038/nrurol.2016.107] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The genomic landscape of testicular germ cell tumour (TGCT) can be summarized using four overarching hypotheses. Firstly, TGCT risk is dominated by inherited genetic factors, which determine nearly half of all disease risk and are highly polygenic in nature. Secondly KIT-KITLG signalling is currently the major pathway that is implicated in TGCT formation, both as a predisposition risk factor and a somatic driver event. Results from genome-wide association studies have also consistently suggested that other closely related pathways involved in male germ cell development and sex determination are associated with TGCT risk. Thirdly, the method of disease formation is unique, with tumours universally stemming from a noninvasive precursor lesion, probably of fetal origin, which lies dormant through childhood into adolescence and then eventually begins malignant growth in early adulthood. Formation of a 12p isochromosome, a hallmark of TGCT observed in nearly all tumours, is likely to be a key triggering event for malignant transformation. Finally, TGCT have been shown to have a distinctive somatic mutational profile, with a low rate of point mutations contrasted with frequent large-scale chromosomal gains. These four hypotheses by no means constitute a complete model that explains TGCT tumorigenesis, but advances in genomic technologies have enabled considerable progress in describing and understanding the disease. Further advancing our understanding of the genomic basis of TGCT offers a clear opportunity for clinical benefit in terms of preventing invasive cancer arising in young men, decreasing the burden of chemotherapy-related survivorship issues and reducing mortality in the minority of patients who have treatment-refractory disease.
Collapse
|
9
|
Abstract
Testicular germ cell tumours are at the crossroads of developmental and neoplastic processes. Their cause has not been fully elucidated but differences in incidences suggest that a combination of genetic and environment factors are involved, with environmental factors predominating early in life. Substantial progress has been made in understanding genetic susceptibility in the past 5 years on the basis of the results of large genome-wide association studies. Testicular germ cell tumours are highly sensitive to radiotherapy and chemotherapy and hence have among the best outcomes of all tumours. Because the tumours occur mainly in young men, preservation of reproductive function, quality of life after treatment, and late effects are crucial concerns. In this Seminar, we provide an overview of advances in the understanding of the epidemiology, genetics, and biology of testicular germ cell tumours. We also summarise the consensus on how to treat testicular germ cell tumours and focus on a few controversies and improvements in the understanding of late effects of treatment and quality of life for survivors.
Collapse
Affiliation(s)
- Ewa Rajpert-De Meyts
- Department of Growth and Reproduction, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disrupting Effects on Male Reproduction and Child Health, Copenhagen, Denmark
| | - Katherine A McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Keisei Okamoto
- Department of Urology, Shiga University of Medical Science, Tsukinowa, Seta, Shiga, Japan.
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Carsten Bokemeyer
- Department of Oncology, Haematology, Bone Marrow Transplantation with section Pneumology, Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
10
|
Elzinga-Tinke JE, Dohle GR, Looijenga LH. Etiology and early pathogenesis of malignant testicular germ cell tumors: towards possibilities for preinvasive diagnosis. Asian J Androl 2016; 17:381-93. [PMID: 25791729 PMCID: PMC4430936 DOI: 10.4103/1008-682x.148079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Malignant testicular germ cell tumors (TGCT) are the most frequent cancers in Caucasian males (20-40 years) with an 70% increasing incidence the last 20 years, probably due to combined action of (epi)genetic and (micro)environmental factors. It is expected that TGCT have carcinoma in situ(CIS) as their common precursor, originating from an embryonic germ cell blocked in its maturation process. The overall cure rate of TGCT is more than 90%, however, men surviving TGCT can present long-term side effects of systemic cancer treatment. In contrast, men diagnosed and treated for CIS only continue to live without these long-term side effects. Therefore, early detection of CIS has great health benefits, which will require an informative screening method. This review described the etiology and early pathogenesis of TGCT, as well as the possibilities of early detection and future potential of screening men at risk for TGCT. For screening, a well-defined risk profile based on both genetic and environmental risk factors is needed. Since 2009, several genome wide association studies (GWAS) have been published, reporting on single-nucleotide polymorphisms (SNPs) with significant associations in or near the genes KITLG, SPRY4, BAK1, DMRT1, TERT, ATF7IP, HPGDS, MAD1L1, RFWD3, TEX14, and PPM1E, likely to be related to TGCT development. Prenatal, perinatal, and postnatal environmental factors also influence the onset of CIS. A noninvasive early detection method for CIS would be highly beneficial in a clinical setting, for which specific miRNA detection in semen seems to be very promising. Further research is needed to develop a well-defined TGCT risk profile, based on gene-environment interactions, combined with noninvasive detection method for CIS.
Collapse
Affiliation(s)
| | | | - Leendert Hj Looijenga
- Department of Pathology, Laboratory of Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
11
|
Rørth M, Grigor KM, Jørgensen N, Skakkebaek NE, Rajpert-De Meyts E. Contralateral biopsy in the management of testicular cancer: what we have learned and what we need to improve. Andrology 2015; 3:99-101. [PMID: 25711180 DOI: 10.1111/andr.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Rørth
- Department of Oncology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
12
|
Litchfield K, Mitchell JS, Shipley J, Huddart R, Rajpert-De Meyts E, Skakkebæk NE, Houlston RS, Turnbull C. Polygenic susceptibility to testicular cancer: implications for personalised health care. Br J Cancer 2015; 113:1512-8. [PMID: 26461055 PMCID: PMC4815881 DOI: 10.1038/bjc.2015.334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/14/2015] [Accepted: 08/19/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The increasing incidence of testicular germ cell tumour (TGCT) combined with its strong heritable basis suggests that stratified screening for the early detection of TGCT may be clinically useful. We modelled the efficiency of such a personalised screening approach, based on genetic risk profiling in combination with other diagnostic tools. METHODS We compared the number of cases potentially detectable in the population under a number of screening models. The polygenic risk scoring (PRS) model was assumed to have a log-normal relative risk distribution across the 19 currently known TGCT susceptibility variants. The diagnostic performance of testicular biopsy and non-invasive semen analysis was also assessed, within a simulated combined screening programme. RESULTS The area under the curve for the TGCT PRS model was 0.72 with individuals in the top 1% of the PRS having a nine-fold increased TGCT risk compared with the population median. Results from population-screening simulations only achieved a maximal positive predictive value (PPV) of 60%, highlighting broader clinical factors that challenge such strategies, not least the rare nature of TGCT. In terms of future improvements, heritability estimates suggest that a significant number of additional genetic risk factors for TGCT remain to be discovered, identification of which would potentially yield improvement of the PPV to 80-90%. CONCLUSIONS While personalised screening models may offer enhanced TGCT risk discrimination, presently the case for population-level testing is not compelling. However, future advances, such as more routine generation of whole genome data is likely to alter the landscape. More targeted screening programs may plausibly then offer clinical benefit, particularly given the significant survivorship issues associated with the successful treatment of TGCT.
Collapse
Affiliation(s)
- Kevin Litchfield
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW3 6JB, UK
| | - Jonathan S Mitchell
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW3 6JB, UK
| | - Janet Shipley
- Division of Molecular Pathology, The Institute of Cancer Research, London SW3 6JB, UK
- Division of Cancer Therapeutics, The Institute of Cancer Research, London SW3 6JB, UK
| | - Robert Huddart
- Academic Radiotherapy Unit, The Institute of Cancer Research, London SW3 6JB, UK
| | - Ewa Rajpert-De Meyts
- Department of Growth and Reproduction, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Niels E Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW3 6JB, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London SW3 6JB, UK
- William Harvey Research Institute, Queen Mary University, London EC1M 6BQ, UK
| |
Collapse
|
13
|
Chemes HE, Venara M, del Rey G, Arcari AJ, Musse MP, Papazian R, Forclaz V, Gottlieb S. Is a CIS phenotype apparent in children with Disorders of Sex Development? Milder testicular dysgenesis is associated with a higher risk of malignancy. Andrology 2015; 3:59-69. [DOI: 10.1111/andr.301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 12/01/2022]
Affiliation(s)
- H. E. Chemes
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá (CEDIE); CONICET; Buenos Aires Argentina
| | - M. Venara
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá (CEDIE); CONICET; Buenos Aires Argentina
| | - G. del Rey
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá (CEDIE); CONICET; Buenos Aires Argentina
| | - A. J. Arcari
- División Endocrinología; Hospital de Niños “Dr. Ricardo Gutiérrez”; Buenos Aires Argentina
| | - M. P. Musse
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá (CEDIE); CONICET; Buenos Aires Argentina
| | - R. Papazian
- Servicio de Endocrinología; Hospital Nacional “Prof. Dr. Alejandro Posadas”; Haedo Argentina
| | - V. Forclaz
- Servicio de Endocrinología; Hospital Nacional “Prof. Dr. Alejandro Posadas”; Haedo Argentina
| | - S. Gottlieb
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá (CEDIE); CONICET; Buenos Aires Argentina
| |
Collapse
|
14
|
|
15
|
Testicular cancer: biology and biomarkers. Virchows Arch 2014; 464:301-13. [DOI: 10.1007/s00428-013-1522-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/25/2013] [Indexed: 12/13/2022]
|
16
|
Expression of PARP1 in primary infertility patients and correlation with DNA fragmentation index a pilot study. J ANAT SOC INDIA 2013. [DOI: 10.1016/j.jasi.2013.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
17
|
Hessel M, Ramos L, Hulsbergen AFC, D'Hauwers KWM, Braat DDM, Hulsbergen-van de Kaa CA. A novel cell-processing method 'AgarCytos' in conjunction with OCT3/4 and PLAP to detect intratubular germ cell neoplasia in non-obstructive azoospermia using remnants of testicular sperm extraction specimens. Hum Reprod 2013; 28:2608-20. [DOI: 10.1093/humrep/det311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
18
|
|
19
|
Rajpert-De Meyts E, Skakkebaek NE. Pathogenesis of testicular carcinoma in situ and germ cell cancer: still more questions than answers. ACTA ACUST UNITED AC 2012; 34:e2-6. [PMID: 21790651 DOI: 10.1111/j.1365-2605.2011.01213.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|