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.
Division of Urologic Surgery and the Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Erik J
EJ
Kouba
Aaron
A
Lentz
Eric M
EM
Wallen
Raj S
RS
Pruthi
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