睾丸生殖细胞肿瘤血清诊断试验的现状与展望

睾丸生殖细胞肿瘤血清诊断试验的现状与展望。The present and future of serum diagnostic tests for testicular germ cell tumours

Testicular germ cell tumours (GCTs) are the most common malignancy occurring in young adult men and the incidence of these tumours is increasing. Current research priorities in this field include improving overall survival for patients classified as being 'poor-risk' and reducing late effects of treatment for patients classified as 'good-risk'. Testicular GCTs are broadly classified into seminomas and nonseminomatous GCTs (NSGCTs). 

睾丸生殖细胞瘤（GCTs）是青年男性最常见的恶性肿瘤，其发病率也在不断上升。目前这一领域的研究重点包括提高“高风险”患者的总体生存率和降低“低风险”患者治疗的后期效果。睾丸GCTs大致分为精原细胞瘤和非精原细胞GCTs（NSGCTs）。

The conventional serum protein tumour markers α-fetoprotein (AFP), human chorionic gonadotrophin (hCG) and lactate dehydrogenase (LDH) show some utility in the management of testicular malignant GCT. However, AFP and hCG display limited sensitivity and specificity, being indicative of yolk sac tumour (AFP) and choriocarcinoma or syncytiotrophoblast (hCG) subtypes.

常规血清蛋白肿瘤标志物甲胎蛋白（AFP）、人绒毛膜促性腺激素（hCG）和乳酸脱氢酶（LDH）在睾丸恶性GCT的治疗中有一定的应用价值。然而，在提示卵黄囊瘤（AFP）和绒毛膜癌或合胞滋养细胞（hCG）亚型上，AFP和hCG表现出有限的敏感性和特异性。

Furthermore, LDH is a very nonspecific biomarker. Consequently, seminomas and NSGCTs comprising a pure embryonal carcinoma subtype are generally negative for these conventional markers. 

此外，乳酸脱氢酶是一种非常非特异性的生物标志物。因此，精原细胞瘤和包含纯胚胎癌亚型的NSGCTs对这些常规标记物通常是阴性的。

As a result, novel universal biomarkers for testicular malignant GCTs are required. MicroRNAs are short, non-protein-coding RNAs that show much general promise as biomarkers. MicroRNAs from two 'clusters', miR-371-373 and miR-302-367, are overexpressed in all malignant GCTs, regardless of age (adult or paediatric), site (gonadal or extragonadal) and subtype (seminomas, yolk sac tumours or embryonal carcinomas). 

因此，睾丸恶性GCTs需要新的通用生物标记物。MicroRNAs是一种短的、非蛋白质编码的rna，作为生物标志物显示出广泛的应用前景。来自miR-371-373和miR-302-367两个“簇”的MicroRNAs在所有恶性gct中都过度表达，无论年龄（成人或儿童）、部位（性腺或性腺外）和亚型（精原细胞瘤、卵黄囊肿瘤或胚胎癌）。

 A panel of four circulating microRNAs from these two clusters (miR-371a-3p, miR-372-3p, miR-373-3p and miR-367-3p) is highly sensitive and specific for the diagnosis of malignant GCT, including seminoma and embryonal carcinoma. 

一组来自这两组（miR-371a-3p，miR-372-3p，miR-373-3p和miR-367-3p）的循环microRNAs对诊断包括精原细胞瘤和胚胎癌在内的恶性GCT具有高度的敏感性和特异性。

In the future, circulating microRNAs might be useful in diagnosis, disease monitoring and prognostication of malignant testicular GCTs, which might also reduce reliance on serial CT scanning. For translation into clinical practice, important practical considerations now need addressing.

在未来，循环microRNAs可能在恶性睾丸gct的诊断、疾病监测和预后预测中发挥作用，这也可能减少对连续CT扫描的依赖。为了转化为临床实践，现在需要解决一些重要的实际问题。