Serum tumor markers may predict overall and disease specific survival in patients with clinically organ confined invasive bladder cancer

Purpose: We assessed the value of increased levels of carcinoembryonic antigen, CA (cancer antigen) 125 and CA (carbohydrate antigen) 19-9 in predicting the survival of patients with clinically organ confined bladder cancer. Materials and Methods: Serum levels of carcinoembryonic antigen, CA 125 and CA 19-9 were measured prospectively in all patients scheduled for cystectomy for clinically organ confined bladder cancer between September 1999 and May 2004. The association between marker levels and overall and disease specific survival rates was assessed, and multivariate analysis was performed to determine the predictive value for outcome. Results: The study included 91 patients with a median followup of 33.5 months (range 3 to 85). Overall and disease specific 5-year survival rates were 47% and 66%, respectively. On univariate analysis CA 19-9 and CA 125 were found to be statistically significant predictors (p <0.001) of overall survival. Respective 1, 2 and 5-year rates were CA 19-9 increased in 65%, 35% and 14%, normal in 83%, 70% and 53%, and CA 125 increased in 50%, 33% and 8%, and normal in 85%, 70% and 55%. CA 19-9 was also a statistically significant predictor (p <0.001) of disease specific survival, with 1, 2 and 5-year rates of 70%, 35% and 24% in patients with high levels vs 89%, 86% and 73% in patients with normal levels. On multivariate Cox regression analysis CA 19-9 (OR 1.5, 95% CI 1.1-2.3, p = 0.02) was an independent predictor of disease specific survival. Conclusions: Increased CA 19-9 and/or CA 125 levels before cystectomy in patients with clinically organ confined muscle invasive bladder cancer are associated with poor outcome. CA 19-9 appears to be an independent predictor of disease specific mortality. Further larger scale studies are needed to confirm these results.