Serum tumor markers predict extravesical disease in clinical stage T2 bladder cancer

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Mar 31 2006

Bladder cancer clinical staging is notoriously poor in patients with muscle invasive disease.

While prospective randomized trials have demonstrated a small survival benefit when neoadjuvant chemotherapy strategies are employed, the selection criteria for preoperative chemotherapy are not well defined. Improving clinical staging with novel imaging or laboratory modalities remains a challenge.

In the April issue of the Journal of Urology, Margel and colleagues evaluated the utility of preoperative levels of CEA, CA-125 or CA 19-9 to predict extravesical disease in patients with clinical stage T2 bladder cancer. Quantitative beta-hcg was not measured. Serum levels of these markers were measured in 91 patients treated with radical cystectomy. Of these patients, 51% (46) had disease localized to the bladder and 49% had extravesical disease. Nineteen percent of patients had evidence of lymph node metastases.

At least one marker was elevated in 66% of patients with extravesical disease. CEA was elevated in 29% of all patients, CA 19-19 in 24%, and CA-125 in 24%. Five patients exhibited elevations in at least 2 serum markers. In multivariate analysis, CEA and CA-125 predicted locally advanced cancer with odds ratios of 8.6 (95% CI 1.51-48.6) and 29.5 (3.6-242.6), respectively. CA-125 and CA 19-9 independently predicted the presence of lymph node metastasis with odds ratios of 22.2 (3.8-129) and 5.2 (1.09-24.76), respectively.

This study adds to the published literature suggesting that approximately one-quarter of patients with muscle invasive bladder cancer may harbor poorly differentiated tumors which produce serum tumor markers. Additional trials are warranted to define the role of serum tumor markers in patient selection for neoadjuvant chemotherapy.

By Ricardo F. Sánchez-Ortiz, MD

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