Blood-Based Biomarkers May Predict Bladder Cancer Outcomes

Levels of CEA and CA 19-9 were significantly higher in patients with tumor recurrence and/or progression.
Levels of CEA and CA 19-9 were significantly higher in patients with tumor recurrence and/or progression.

NEW ORLEANS—Blood-based tumor markers may be useful tools for follow-up of non-muscle invasive urothelial bladder carcinoma, according to research presented at the 2015 American Urological Association annual meeting.

Predictive blood-based biomarkers may reduce the burden of invasive tests, said lead researcher Daher Chade, MD, of São Paulo Cancer Institute at the University of Sao Paulo in Brazil.

For the study, the investigators measured serum levels of CEA (carcinoembryonic antigen), CA 19-9 (carbohydrate antigen; sialylated Lewis A antigen), and CA 125 (carbohydrate antigen; mucin 16 or MUC16) in 446 patients before the first transurethral resection of bladder tumor (TURBT). The majority of patients (71%) were men.

According to pathology reports at first TURBT, more than half of patients (59%) had Ta cancer, and the remaining patients had T1 cancer; concomitant carcinoma in situ was present in 12%. Patients received intravesical bacillus Calmette-Guérin (BCG) treatment for non-muscle invasive high-grade disease, carcinoma in situ, previous recurrence, or T1 cancer. Follow-up included routine cystoscopy, cytology, and imaging every 6 months for almost 3 years. Those who developed high-risk disease had another TURBT.

The investigators discovered that levels of CEA and CA 19-9 were significantly higher in patients who experienced tumor recurrence and/or progression compared with patients who did not. Average CEA levels were 6.4 versus 3.9 ng/mL, respectively, and average CA 19-9 levels were 24.9 versus 16.1 U/mL, respectively. Levels of CA 125 did not differ between the groups, but the investigators urged additional research before excluding this potential biomarker.

If the findings are validated, “preoperative CEA and CA 19-9 levels may be able to distinguish a higher risk group of patients,” the researchers concluded.

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