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Impact of circulating microRNA test (miRNA‐371a‐3p) on appropriateness of treatment and cost outcomes in patients with Stage I non‐seminomatous germ cell tumours
Author(s) -
Bagrodia Aditya,
Savelyeva Anna,
Lafin John T.,
Speir Ryan W.,
Chesnut Gregory T.,
Frazier Anne Lindsay,
Woldu Solomon L.,
Margulis Vitaly,
Murray Matthew J.,
Amatruda James F.,
Lotan Yair
Publication year - 2021
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.15288
Subject(s) - medicine , retroperitoneal lymph node dissection , stage (stratigraphy) , germ cell tumors , testicular cancer , oncology , cancer , disease , surgery , chemotherapy , paleontology , biology
Objectives To determine whether utilisation of a serum microRNA (miRNA) test could improve treatment appropriateness and cost‐effectiveness for patients with Stage I non‐seminomatous germ cell tumours (NSGCTs). Patients and Methods 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 tumour markers and radiographic staging (standard model) to a miRNA‐based approach using the standard model + post‐orchidectomy 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. Results Utilising the 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 and IB, respectively. The miRNA‐based approach remained cost‐effective over a wide range of performance characteristics with savings of ~$1400 (American dollars)/patient for both Stage IA and IB disease. Conclusion A miRNA‐based approach may potentially select patients with Stage I NSGCT for correct treatment in a cost‐effective manner. Identification of residual teratoma‐only remains an issue. Prospective studies are necessary to validate these findings.