Objectives: To determine whether utilization of serum miRNA test could improve treatment appropriateness and cost-effectiveness for stage I NSGCT patients.
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 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.
Results: 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.
Conclusion: 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.
