Prediction of extravesical disease by preoperative serum markers in patients with clinically organ confined invasive bladder cancer.
OBJECTIVE
We assessed the value of preoperative levels of CEA, CA-125 or CA 19-9 in patients with clinically organ confined bladder cancer to predict pathological extravesical and/or node positive disease.


METHODS
Serum levels of CEA, CA-125 and CA 19-9 were measured prospectively in all patients scheduled for cystectomy for clinically organ confined bladder cancer between September 1999 and May 2004. Biomarker expression was compared between patients with pathologically organ confined disease (pT2 or less, pN0) and patients with extravesical disease (greater than pT2, or pN1 or greater), and between patients with pathologically node negative (any pT, pN0) and node positive disease (any pT, pN1 or greater).


RESULTS
Of the 91 patients enrolled, 46 had (51%) pathologically organ confined tumors, 45 (49%) had extravesical disease and 17 (19%) had positive lymph nodes. Preoperative serum levels of all markers were significantly higher in cases of extravesical disease than in organ confined disease. On multivariate analysis CEA with an odds ratio of 8.6 (95% CI 1.51-48.6) and CA-125 with an OR of 29.5 (95% CI 3.6-242.6) proved independent predictors of extravesical disease. CA-125 and CA 19-9 levels were significantly higher in patients with node positive disease than in those with node negative disease. On multivariate analysis CA-125 with an OR of 22.2 (95% CI 3.8-129) and CA 19-9 with an OR of 5.2 (95% CI 1.09-24.76) proved independent predictors of node positive disease.


CONCLUSIONS
Increase in serum tumor markers before cystectomy in patients with clinically organ confined muscle invasive bladder cancer is a strong indicator of the presence of extravesical and node positive disease.
Margel
David
D
Institute of Urology, Rabin Medical Center - Beilinson Campus, Petach Tikva, Israel. sdmargel@bezeqint.net
Tal
Raanan
R
Neuman
Avivit
A
Konichezky
Myriam
M
Sella
Avishai
A
Baniel
Jack
J
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery
D014408:Biomarkers, Tumor