Clinical use of serum CA-125 levels in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder.
OBJECTIVE
It has recently been reported that serum CA-125 levels may serve as a prognostic indicator of extravesical disease in patients with bladder cancer. This study evaluated the role of CA-125 as a prognostic marker in patients with transitional cell carcinoma of the bladder undergoing radical cystectomy and urinary diversion.


METHODS
Ninety-two consecutive patients underwent planned radical cystectomy and urinary diversion with curative intent (2005-2006). Serum CA-125 levels were obtained in all patients and correlations were made to clinical and operative findings and pathological outcomes. Outcomes were evaluated with regard to normal vs. abnormal CA-125 values and with regard to absolute values of CA-125 levels. Results were also stratified by short-term recurrence rates.


RESULTS
Mean CA-125 values varied significantly by pathological stage and by resectability. No patient (0/56) with organ-confined disease (<or= pT2N0) had an abnormal CA-125, and only 1 patient (1/75 = 1.3%) with <or= pT3N0 disease had an abnormal value. Conversely, 35% of patients with regionally-advanced disease (pT4 or N+) had an elevated CA-125, and all patients with unresectable disease (5/5) had an elevated value. In addition, patients with abnormal values of CA-125 (i.e., <35 U/ml) had a significantly higher upstaging rate compared to non-upstaged patients (18.8% vs. 3.5%, respectively; P = 0.0233). As well, patients with CA-125 levels <15 U/ml had a significantly higher upstaging rate compared with non-upstaged patients (53.1% vs. 15.8%, respectively; P = 0.0005). At a mean follow-up of 15 months (median = 14 months), patients with T2/T3N0 disease who recurred had a higher mean value than patients with pT2/T3 disease who did not recur (20.1 vs. 10.8 U/ml).


CONCLUSIONS
Serum CA-125 levels may serve as a useful predictor of pathological outcomes in patients undergoing cystectomy for urothelial carcinoma of the bladder. Further studies will be carried out to determine the predictability of CA-125 on long-term recurrence and survival rates, and to evaluate the utility of CA-125 as a marker for disease response in patients with recurrent or advanced disease undergoing systemic therapy.
Kouba
Erik J
EJ
Division of Urologic Surgery and the Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Lentz
Aaron
A
Wallen
Eric M
EM
Pruthi
Raj S
RS
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000473:pathology / Q000601:surgery; D015653:Cystectomy; D005260:Female; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen