Prognostic Significance of Systemic Inflammation Markers in Testicular and Penile Cancer: A Narrative Review of Current Literature

Abstract

In contemporary clinical practice, biomarkers are indispensable in the assessment and management of oncological patients. Although established serum tumor markers (beta human chorionic gonadotropin (bHCG), alpha fetoprotein (AFP), and lactate dehydrogenase (LDH)) have an indisputably important role in the management of patients with testicular cancer (TC), the application of these tumor markers may be accompanied with certain limitations, implying the need for additional biomarkers. Contrary to TC, there is a lack of established serological biomarkers for penile cancer (PC) and the management of this urological malignancy is based on multiple clinicopathological parameters. Therefore, the identification and rigorous analytical and clinical validation of reliable biomarkers are considered pivotal for improving PC management. Inflammation may be associated with all stages of oncogenesis, from initial neoplastic transformation to angiogenesis, tissue invasion, and metastasis. Accordingly, an array of inflammation-related indices have gained increasing attention as emerging predictors of oncological outcomes. The clinical usefulness of systemic inflammation markers was reported in many urological and non-urological malignancies. The aim of this narrative review is to summarize current scientific data regarding the prognostic and predictive significance of systemic inflammation markers in TC and PC patients.

Epigenetic Factors and ncRNAs in Testicular Cancer

“…(1) Alpha-fetoprotein (AFP): A protein produced during fetal development. Elevated AFP levels are commonly used as a diagnostic and monitoring tool for testicular cancer and can also predict the response to chemotherapy in patients [64]. (2) Human chorionic gonadotropin (HCG): HCG is a hormone produced during pregnancy, but elevated levels of HCG are also frequently observed in testicular cancer.…”

“…Studies have found that HCG levels can be a significant predictor of relapse in patients with testicular cancer [65,66]. (3) Lactate dehydrogenase (LDH): Elevated levels of LDH are associated with testicular cancer, and this metabolic enzime is often used as a predictor of overall survival in patients [64]. miRNAs: miRNAs are small RNA molecules involved in gene regulation; specific miRNAs are dysregulated in testicular cancer and can serve as biomarkers for the disease.…”

Multifocality in Testicular Cancer: Clinicopathological Correlations and Prognostic Implications

“…Similarly, lymphovascular invasion (LVI) has been recognized as a reliable prognostic factor for relapse in clinical stage I NSGCT patients, guiding risk-adapted treatment strategies [7]. Systemic inflammation indices, particularly the neutrophile-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR), have demonstrated the potential for complementing and improving existing biomarkers and clinicopathological variables in GCT patients [8]. The utilization of advanced techniques like next-generation sequencing (NGS) and multiomics has led to the identification of several promising prognostic factors in TC patients [9,10].…”