To determine whether utilization of serum miRNA test could improve treatment appropriateness and cost-effectiveness for stage I NSGCT patients.
A decision tree model was built to investigate treatment course, clinical and cost outcomes for patients with Stage IA (T1N0M0S0) and IB (T2-4N0M0S0) NSGCT. The model compared outcomes and cost of standard approach using histopathology, conventional serum tumor markers and radiographic staging [standard model] to a miRNA-based approach using standard model + post-orchiectomy serum miR-371a-3p [marker model]. Probabilities of expected treatment and outcomes were based on presence/absence of cancer upon entering into the model. Overtreatment was defined as adjuvant chemotherapy or primary retroperitoneal lymph node dissection in a patient without cancer. Undertreatment was defined as initial surveillance for a patient with cancer.
Utilizing miRNA marker-based approach, 26% of patients avoid overtreatment and 8% avoid undertreatment in Stage IA NSGCT; 27% avoid overtreatment and 23% avoid undertreatment in Stage IB disease. Appropriate treatment decision-making increased from 65% to 94% and 50% to 92% for Stage IA/IB, respectively. The miRNA-based approach remained cost-effect over a wide range of performance characteristics with savings of approximately $1400/patient for both stage IA/IB disease.
A miRNA-based approach may potentially select Stage I NSGCT patients for correct treatment in a cost-effective manner. Identification of residual teratoma-only remains an issue. Prospective studies are necessary to validate these findings.
BJU international. 2020 Oct 30 [Epub ahead of print]
Aditya Bagrodia, Anna Savelyeva, John T Lafin, Ryan W Speir, Gregory T Chesnut, A Lindsay Frazier, Solomon L Woldu, Vitaly Margulis, Matthew J Murray, James F Amatruda, Yair Lotan
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA., Walter Reed National Military Medical Center, Bethesda, MD, USA., Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA., Department of Pathology, University of Cambridge, Cambridge, UK., Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, California, USA.