NEW ORLEANS, LA USA (UroToday.com) - In this study from the University of Southern California, the authors looked at levels of epithelial tumor markers CA 125, CA 19-9 and CEA at various time points during therapy for invasive bladder cancer to assess their utility in prognostication of clinical course. High CA 125, CA 19-9, and CEA levels are associated with worse oncologic outcomes in bladder cancer.
The authors first focused on 12 patients with available serum marker data available before and after neoadjuvant chemotherapy (NAC), who were found to have elevated levels of at least one of the markers prior to NAC. For 7 of these patients the markers normalized after NAC and for 5 they did not. Of the 7 whose markers normalized, only 1 ultimately died. In contrast 4 of the 5 patients whose markers did not normalize died at a median of 5 months.
In looking at patients prior to cystectomy, the authors reported that elevated levels of CA 125, CA 19-9, or CEA were present in 63 of 202 patients (31%). These patients experienced a 4-fold increased risk of recurrent disease following cystectomy and a hazard ratio for death of nearly 20 as demonstrated on Cox regression modeling. Furthermore the authors reported that elevated levels of CA 125 or CA 19-9 were associated with disease recurrence, and elevated levels of all 3 markers was strongly predictive of death.
The authors concluded that these markers are useful for predicting mortality and recurrence after cystectomy in patients with invasive bladder cancer, and that persistently elevated markers portend worse outcomes. The authors also reported they are examining the usefulness of these markers in a surveillance capacity post-cystectomy, which might provide a more sensitive alternative for identifying recurrent disease before it is visible on imaging.
Presented by Soroush T. Bazarganim, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of Southern California, Los Angeles, CA USA
Reported by Timothy Ito, MD, medical writer for UroToday.com