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Aktuelle Urol 2024; 55(06): 510-519
DOI: 10.1055/a-2358-8355
Übersicht

Hodentumor – welche Vorteile bringt der neue Tumormarker microRNA-371a-3p (M371-Test)

Testicular Germ Cell Tumours – features and prospects of the novel tumour marker microRNA-371a-3p (M371 test): a narrative review
Klaus-Peter Dieckmann 
1   Urologie, Asklepios Klinik Altona, Hamburg, Germany (Ringgold ID: RIN14917)
,
Gazanfer Belge
2   Universität Bremen, Institut für Tumordiagnostik, Bremen, Germany
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Zusammenfassung

Der Keimzelltumor des Hodens ist ein Musterbeispiel für die Verwendung von Serum-Tumormarkern. Das Dilemma ist, dass die aktuellen Marker beta Human Chorion Gonadotropin (bHCG) und Alpha Fetoprotein (AFP) sowie Laktatdehydrogenase (LDH) nur etwa bei 50% aller Keimzelltumoren erhöht sind. Im Jahre 2011 wurde erstmals die microRNA-371a-3p (M371) als neuer Tumormarker vorgeschlagen. MicroRNAs sind kleine RNA-Fragmente von 18–24 Basenpaaren, die eine epigenetische Bedeutung bei der Steuerung der Proteinbiosynthese haben. Die M371 kann im Serum mit PCR-Technik gemessen werden.

Mit einem hohen Maß an formaler Evidenz konnte gezeigt werden, dass M371 eine Sensitivität von etwa 90% und eine Spezifität von über 90% für Keimzelltumoren des Hodens aufweist. Die M371 ist dabei für Seminome und Nichtseminome gleichermaßen sensitiv und spezifisch. Allerdings exprimieren Teratome den Marker nicht, wie auch nichtgerminale Hodentumoren und Karzinome anderer Organe. Der Marker weist eine sehr kurze Halbwertszeit von <24 Stunden auf.

In naher Zukunft darf erwartet werden, dass der Test substanzielle Hilfe geben wird bei vielen klinischen Entscheidungssituationen, die bisher nur unbefriedigend zu lösen waren. Dies dürfte vor allem für die folgenden sechs Szenarien zutreffen: (1) Abklärung eines zufällig entdeckten kleinen Hodentumors mit Weichenstellung in Richtung organerhaltender Exzision versus Ablatio testis; (2) Vereinfachung der Nachsorge von Hodentumoren durch Reduktion der Bildgebung; (3) Einschätzung unklarer Lymphknotenvergrößerungen im Rahmen des klinischen Stagings; (4) Abklärung von unklaren (falsch positiven) Erhöhungen der klassischen Tumormarker; (5) rasche Beurteilung des Ansprechens auf Therapie aufgrund der kurzen Halbwertszeit; (6) Hilfe bei der Entscheidungsfindung für die Behandlung von Residualtumoren nach Chemotherapie, insbesondere bei Resttumoren des Seminoms.

Die Entdeckung und Entwicklung des Tumormarkers M371 stellt einen Meilenstein dar bei der Ausformung pragmatischer Therapiekonzepte für Keimzelltumoren.

Abstract

Testicular germ cell tumours (GCTs) represent a paradigm for the usefulness of serum tumour markers in clinical management of diseases. However, the tumour markers currently in use, beta human chorionic gonadotropin (bHCG), alpha fetoprotein (AFP) and lactate dehydrogenase (LDH) are expressed in less than 50% of GCT cases. In 2011, microRNA-371a-3p (currently named M371) was suggested as a novel marker for the first time. Chemically, microRNAS represent small RNA molecules consisting of 18–24 base pairs. Physiologically, these microRNAs play a prominent role in the epigenetic control of protein biosynthesis. M371 can be measured in serum with PCR-techniques.

There is high level evidence for a 90% sensitivity and >90% specificity for GCTs of the marker M371. That high diagnostic accuracy is true for both seminoma and nonseminoma but not for the histologic subgroup of teratoma. Testicular tumours of non-germ cell origin and malignant neoplasms of other organs do not express the marker. M371 involves a very short half-life of <24 hours.

The test does likely involve the prospects of providing substantial aid in clinical decision-making with respect to instances where improvement of GCT management is still required. In particular, the following clinical scenarios will probably benefit from the employment of the M371 test: (1) diagnostic work-up of incidentally detected small testicular masses with decision-making in regard to testis sparing surgery or full orchiectomy (2) simplifying the follow-up of GCT patients with sparing of imaging procedures in a number of cases; (3) diagnostic evaluation of retroperitoneal lymphadenopathy upon clinical staging; (4) diagnostic evaluation of false-positive elevations of classical tumour markers (AFP, bHCG); (5) rapid appraisal of therapeutic success or failure by means of the very short half-life of M371; (6) diagnostic evaluation of postchemotherapy residual masses particularly those in seminoma patients.

The discovery and development of the novel tumour marker M371 probably represents a milestone progress in the history of the clinical management of testicular GCTs.

Schlüsselwörter

Keimzelltumor - Seminom - Nichtseminom - Teratom - microRNA 371 - Tumormarker

Keywords

Testicular germ cell tumor - seminoma - tumour marker - microRNA-371 - non-seminoma


Publication History

Received: 08 April 2024

Accepted after revision: 24 June 2024

Article published online:
12 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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