PURPOSE: To evaluate the diagnostic efficacy of serum microRNAs in predicting pathologic findings of retroperitoneal lymph node dissection (RPLND) in patients with testicular germ cell tumors (TGCT). METHODS: PUBMED, SCOPUS, and Cochrane Library were searched in August 2024 to identify eligible studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. RESULTS: Nine studies comprising 603 patients were selected in this review. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of microRNA-371a-3p for predicting viable tumor other than pure teratoma in RPLND specimen were 0.76 (95% CI 0.49-0.90), 0.97 (95% CI 0.81-0.99) and 31.75 (95% CI 9.24-109.10), respectively. The pooled sensitivity for primary and post-chemotherapy RPLND (PC-RPLND), were 0.77 (95% CI 0.47-0.93) and 0.73 (95% CI 0.28-0.95), respectively. The pooled specificity for primary and PC-RPLND were 0.92 (95% CI 0.72-0.98) and 0.99 (95% CI 0.62-1.00), respectively. The pooled DOR for primary and PC-RPLND were 13.86 (95% CI 2.97-64.79) and 64.11 (95% CI 13.09-313.98), respectively. The major limitation is the lack of standardization of miR371 testing. CONCLUSION: miR-371a-3p is a relatively sensitive and highly specific marker for predicting viable tumors in RPLND pathologic findings. The DOR was particularly significant for patients who underwent PC-RPLND. While serum microRNAs may be useful in distinguishing viable germ cell tumors from necrosis, fibrosis, and teratomas, their ability to differentiate teratomas from necrosis is limited. Well-designed prospective studies are essential to enhance our understanding of the predictive performance of microRNAs.

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Comprehensive Cancer Center Vienna General Hospital Medical University of Vienna Währinger Gürtel 18 20 1090 Vienna Austria

Department of Urology Faculty of Medicine Shimane University Shimane Japan

Department of Urology Jikei University School of Medicine Tokyo Japan

Department of Urology Shariati Hospital Tehran University of Medical Sciences Tehran Iran

Department of Urology University of California San Diego San Diego CA USA

Department of Urology University of Southern California Norris Comprehensive Cancer Center Los Angeles CA USA

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology Uro Oncology Robot Assisted and Specialized Urologic Surgery University Hospital Cologne Cologne Germany

Departments of Urology Weill Cornell Medical College New York NY USA

Division of Urology Department of Special Surgery The University of Jordan Amman Jordan

James Buchanan Brady Urological Institute Johns Hopkins University Baltimore MD USA

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Research Center for Evidence Medicine Urology Department Tabriz University of Medical Sciences Tabriz Iran

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