title: Precystectomy serum levels of carbohydrate antigen 19-9, carbohydrate antigen 125, and carcinoembryonic antigen: prognostic value in invasive urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  To evaluate the prognostic value of precystectomy carbohydrate antigen 19-9 (CA 19-9), carbohydrate antigen 125 (CA 125), and carcinoembryonic antigen (CEA) levels in invasive urothelial carcinoma of the bladder (UCB).
  
  
  METHODS
  Preoperatively collected serum samples from patients with invasive UCB who underwent radical cystectomy between 2004 and 2009 were used to measure CA 19-9, CA 125, and CEA levels. Laboratory cutoff points were used to define elevated marker levels (CA 19-9>37 U/ml, CA 125>35 U/ml, and CEA>3.8 U/ml). The Cox regression model was used to identify independent predictors of recurrence-free survival (RFS) and overall survival (OS).
  
  
  RESULTS
  A total of 186 patients with the mean age of 69 years (range: 36-89) and median follow-up of 4 years (range: 0.1-7.2) were included in the study. Overall, 94 (51%) patients had pathologic organ-confined disease (≤T2) and 92 (49%) had pathologic locally advanced UCB (pT3-T4 or positive lymph node or both). The mean CA 19-9, CA 125, and CEA levels were 11.6 U/ml (range:<0.6-111), 11.5 U/ml (range: 3-56), and 2.2 ng/ml (range: 0.3-30.2), respectively. Levels of CA 19-9, CEA, and CA 125 were elevated in 7 (3%), 25 (13%), and 3 (1%) patients, respectively. Median 3-year RFS and OS were 72%. Using the multivariate Cox regression model, elevated levels of CA 19-9 and CEA were found to be independent predictors of worse 3-year OS (hazard ratio [HR] = 2.7, P = 0.05 and HR = 2, P = 0.03, respectively), and an elevated level of CA 19-9 was an independent predictor of worse 3-year RFS (HR = 2.8, P = 0.05). Precystectomy CA 125 level was not associated with oncological outcome.
  
  
  CONCLUSIONS
  Elevated precystectomy serum levels of CA 19-9 and CEA are independent predictors of worse oncological outcome in patients with invasive UCB. Further studies are needed to elucidate the role of these markers in the management of UCB.
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Hamed
authors.initials: H
authors.lastname: Ahmadi
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Hooman
authors.initials: H
authors.lastname: Djaladat
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA.
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.affiliation: Institute of Urology, University of Southern California, Los Angeles, CA. Electronic address: daneshma@med.usc.edu.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000097:blood*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000473:pathology*; D019459:Urothelium / Q000473:pathology*
chemical_list: D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins
keywords: Bladder cancer; Carbohydrate antigen 125; Carbohydrate antigen 19-9; Carcinoembryonic antigen; Prognosis; Serum tumor markers