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Lin HJ, Hu RM, Chen HC, Lin CC, Lee CY, Chou CY. CA125 for the Diagnosis of Advanced Urothelial Carcinoma of the Bladder: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030813. [PMID: 36765770 PMCID: PMC9913454 DOI: 10.3390/cancers15030813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Urothelial carcinoma of the bladder (UCB) is the second most common genitourinary cancer. This study aims to assess the diagnostic accuracy of CA125 in advanced UCB. METHODS We searched prevalent studies in PubMed, the Cochrane Library, Scopus, Embase, the Web of Science China National Knowledge Infrastructure database, and Wanfang data before October 2022. Pooled sensitivity, specificity, and summary receiver operating characteristics were used to assess the diagnostic value of CA125. RESULTS One thousand six hundred forty-one patients from 14 studies were analyzed. UCB stage T3-4N1 was defined as advanced UCB in ten studies; T2-4 was used in three studies; and N1M1 in one study. Patients' age was between 21 to 92, and 21% to 48.6% of patients were female. The pooled sensitivity was 0.695 (95% confidence interval (CI): 0.426-0.875). The pooled specificity was 0.846 (95% CI: 0.713-0.924). The diagnostic odds ratio was 8.138 (95% CI: 4.559-14.526). The AUC was 0.797. CONCLUSION CA125 may provide significant diagnostic accuracy in identifying muscle-invasive, lymph node-involved, and distant metastatic tumors in patients with urothelial carcinoma of the bladder. Limited studies have been conducted on the prognostic role of CA125. More studies are needed for a meta-analysis on the prognostic role of CA125 in UCB.
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Affiliation(s)
- Hsuan-Jen Lin
- Division of Nephrology, Asia University Hospital, Taichung 41354, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
| | - Rouh-Mei Hu
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
| | - Hung-Chih Chen
- Division of Nephrology, Asia University Hospital, Taichung 41354, Taiwan
| | - Chung-Chih Lin
- Division of Nephrology, Asia University Hospital, Taichung 41354, Taiwan
| | - Chi-Yu Lee
- Division of Nephrology, Asia University Hospital, Taichung 41354, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, Taichung 41354, Taiwan
- College of Medicine, China Medical University, Taichung 404332, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Post-baccalaureate Veterinary Medicine, Asia University, Taichung 41354, Taiwan
- Correspondence: ; Tel.: +886-4-3706-1668-1878; Fax: +886-4-3706-1668-1338
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Bazargani ST, Clifford TG, Djaladat H, Schuckman AK, Wayne K, Miranda G, Cai J, Sadeghi S, Dorff T, Quinn DI, Daneshmand S. Association between precystectomy epithelial tumor marker response to neoadjuvant chemotherapy and oncological outcomes in urothelial bladder cancer. Urol Oncol 2018; 37:1-11. [PMID: 30470611 DOI: 10.1016/j.urolonc.2018.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/16/2018] [Accepted: 09/12/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES We previously reported that elevated precystectomy serum levels of epithelial tumor markers predict worse oncological outcome in patients with invasive bladder cancer (BC). Herein, we evaluated the effect of neoadjuvant chemotherapy (NAC) on elevated tumor marker levels and their association with oncological outcomes. METHODS Under IRB approval, serum levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 480 patients with invasive BC from August 2011 through December 2016. In the subgroup undergoing NAC, markers were measured prior to the first and after the last cycle of chemotherapy (prior to cystectomy). RESULTS Three hundred and thirty-seven patients were eligible for the study, with a median age was 71 years (range 34-93) and 81% (272) male. Elevated precystectomy level of any tumor markers (31% of patients) was independently associated with worse recurrence-free survival (hazard ratio [HR] = 2.81; P < 0.001) and overall survival (HR = 3.97; P < 0.001). One hundred and twenty-five (37%) patients underwent NAC, of whom 59 had a complete tumor marker profile and 30 (51%) had an elevated pre-NAC tumor marker. Following completion of chemotherapy, 10/30 (33%) patients normalized their tumor markers, while 20/30 (67%) had one or more persistently elevated markers. There was no difference in clinical or pathological stage between groups (P = 0.54 and P = 0.09, respectively). Further analysis showed a significantly lower rate and longer median time to recurrence/progression in the responder group (50% in responders vs. 90% in nonresponders at a median time of 22 vs. 4.8 months, respectively; P = 0.015). There was also significant difference in mortality rates and median overall survival between the study groups (30% in responders vs. 70% in nonresponders at a median time of 27.3 vs. 11.6 months respectively; P = 0.037). Two of the three patients that died in the normalized tumor marker group had tumor marker relapse at recurrence prior to their death. CONCLUSIONS To our knowledge, this is the first study showing tumor marker response to NAC. Patients with persistently elevated markers following NAC have a very poor prognosis following cystectomy, which may help identifying chemotherapy-resistant tumors. A larger, controlled study with longer follow up is needed to determine their role in predicting survival.
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Key Words
- BC, bladder cancer
- Bladder cancer
- CA 125, carbohydrate antigen 125
- CA 19-9, carbohydrate antigen 19-9
- CAMs, cellular adhesion molecules
- CEA, carcinoembryonic antigen
- NAC, neoadjuvant chemotherapy
- Neoadjuvant chemotherapy
- Oncological outcomes
- Prognosis
- RC, radical cystectomy
- TM, tumor markers
- TURBT, transurethral resection of bladder tumor
- Tumor markers
- UBC, urothelial bladder cancer
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Affiliation(s)
- Soroush T Bazargani
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA
| | - Thomas G Clifford
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA
| | - Hooman Djaladat
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA
| | - Anne K Schuckman
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA
| | - Kevin Wayne
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA
| | - Gus Miranda
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA
| | - Jie Cai
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA
| | - Sarmad Sadeghi
- Department of Clinical Medicine, Section of Genitourinary (Gu) Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Tanya Dorff
- Department of Clinical Medicine, Section of Genitourinary (Gu) Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - David I Quinn
- Department of Clinical Medicine, Section of Genitourinary (Gu) Oncology, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Siamak Daneshmand
- Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA.
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Margel D, Bostrom P, Baniel J, Yossepowitch O, Zlotta A, Fleshner N. External Validation of a Biomarker Based Pre-Cystectomy Algorithm to Predict Nonorgan Confined Urothelial Cancers. J Urol 2012; 187:840-4. [DOI: 10.1016/j.juro.2011.10.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Indexed: 11/26/2022]
Affiliation(s)
- David Margel
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada
- Institute of Urology, Rabin Medical Center-Beilinson, Petach Tikva, and the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Peter Bostrom
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada
| | - Jack Baniel
- Institute of Urology, Rabin Medical Center-Beilinson, Petach Tikva, and the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Institute of Urology, Rabin Medical Center-Beilinson, Petach Tikva, and the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Alexandre Zlotta
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Canada
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[Validation of pre-cystectomy nomograms for the prediction of locally advanced urothelial bladder cancer in a multicentre study: are we able to adequately predict locally advanced tumour stages before surgery?]. Urologe A 2011; 50:706-13. [PMID: 21340594 DOI: 10.1007/s00120-011-2506-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Pre-cystectomy nomograms with a high predictive ability for locally advanced urothelial carcinomas of the bladder would enhance individual treatment tailoring and patient counselling. To date, there are two currently not externally validated nomograms for prediction of the tumour stages pT3-4 or lymph node involvement. MATERIALS AND METHODS Data from a German multicentre cystectomy series comprising 2,477 patients with urothelial carcinoma of the bladder were applied for the validation of two US nomograms, which were originally based on the data of 726 patients (nomogram 1: prediction of pT3-4 tumours, nomogram 2: prediction of lymph node involvement). Multivariate regression models assessed the value of clinical parameters integrated in both nomograms, i.e. age, gender, cT stage, TURB grade and associated Tis. Discriminative abilities of both nomograms were assessed by ROC analyses; calibration facilitated a comparison of the predicted probability and the actual incidence of locally advanced tumour stages. RESULTS Of the patients, 44.5 and 25.8% demonstrated tumour stages pT3-4 and pN+, respectively. If only one case of a previously not known locally advanced carcinoma (pT3-4 and/or pN+) is considered as a staging error, the rate of understaging was 48.9% (n=1211). The predictive accuracies of the validated nomograms were 67.5 and 54.5%, respectively. The mean probabilities of pT3-4 tumours and lymph node involvement predicted by application of these nomograms were 36.7% (actual frequency 44.5%) and 20.2% (actual frequency 25.8%), respectively. Both nomograms underestimated the real incidence of locally advanced tumours. CONCLUSIONS The present study demonstrates that prediction of locally advanced urothelial carcinomas of the bladder by both validated nomograms is not conferrable to patients of the present German cystectomy series. Hence, there is still a need for statistical models with enhanced predictive accuracy.
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Abogunrin F, O'Kane HF, Ruddock MW, Stevenson M, Reid CN, O'Sullivan JM, Anderson NH, O'Rourke D, Duggan B, Lamont JV, Boyd RE, Hamilton P, Nambirajan T, Williamson KE. The impact of biomarkers in multivariate algorithms for bladder cancer diagnosis in patients with hematuria. Cancer 2011; 118:2641-50. [PMID: 21918968 DOI: 10.1002/cncr.26544] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/26/2011] [Accepted: 06/21/2011] [Indexed: 01/30/2023]
Abstract
BACKGROUND We appraised 23 biomarkers previously associated with urothelial cancer in a case-control study. Our aim was to determine whether single biomarkers and/or multivariate algorithms significantly improved on the predictive power of an algorithm based on demographics for prediction of urothelial cancer in patients presenting with hematuria. METHODS Twenty-two biomarkers in urine and carcinoembryonic antigen (CEA) in serum were evaluated using enzyme-linked immunosorbent assays (ELISAs) and biochip array technology in 2 patient cohorts: 80 patients with urothelial cancer, and 77 controls with confounding pathologies. We used Forward Wald binary logistic regression analyses to create algorithms based on demographic variables designated prior predicted probability (PPP) and multivariate algorithms, which included PPP as a single variable. Areas under the curve (AUC) were determined after receiver-operator characteristic (ROC) analysis for single biomarkers and algorithms. RESULTS After univariate analysis, 9 biomarkers were differentially expressed (t test; P < .05). CEA AUC 0.74; bladder tumor antigen (BTA) AUC 0.74; and nuclear matrix protein (NMP22) 0.79. PPP included age and smoking years; AUC 0.76. An algorithm including PPP, NMP22, and epidermal growth factor (EGF) significantly improved AUC to 0.90 when compared with PPP. The algorithm including PPP, BTA, CEA, and thrombomodulin (TM) increased AUC to 0.86. Sensitivities = 91%, 91%; and specificities = 80%, 71%, respectively, for the algorithms. CONCLUSIONS Addition of biomarkers representing diverse carcinogenic pathways can significantly impact on the ROC statistic based on demographics. Benign prostate hyperplasia was a significant confounding pathology and identification of nonmuscle invasive urothelial cancer remains a challenge.
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Affiliation(s)
- Funso Abogunrin
- Centre for Cancer Research & Cell Biology, Queens University Belfast, Belfast, Ireland
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Margel D, Harel A, Yossepowitch O, Baniel J. A novel algorithm to improve pathologic stage prediction of clinically organ-confined muscle-invasive bladder cancer. Cancer 2009; 115:1459-64. [PMID: 19152435 DOI: 10.1002/cncr.24138] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND An algorithm was created to predict pathologic stage in patients with clinically organ-confined muscle-invasive bladder cancer. METHODS The sample consisted of 133 consecutive patients scheduled to undergo cystectomy. To develop a tool to predict nonorgan-confined disease before surgery, principal component analysis (PCA) was applied. Patients were stratified into a training set (n = 89) and a validation set (n = 44), and 7 parameters were evaluated: levels of carcinoembryonic antigen, cancer antigen (CA) 125, and carbohydrate antigen (CA) 19-9; clinical stage; presence of hydronephrosis; presence of carcinoma in situ; and initial tumor size >3 cm. PCA was applied to the training set to determine the weight of each parameter. A PCA score was generated for each patient in the set, and a cutoff defining nonorgan-confined disease was established. The accuracy of the cutoff was quantified by the area under the receiver operator characteristics curve (AUC). The model was then applied to the validation set without recalculation; the AUC and the positive and negative predictive values of the validation set were calculated. RESULTS On pathologic evaluation, 71 patients (53%) were found to have organ-confined tumors and 62 patients (47%) had extravesical disease. The AUC was 0.85 in the training group (95% confidence interval [95% CI], 0.71-0.97) and 0.84 in the validation group (95% CI, 0.75-0.93). The positive and negative predictive values in the validation group were 88% (95% CI, 71%-96%) and 94% (95% CI, 71%-99%), respectively. CONCLUSIONS The newly devised, internally validated, algorithm was 85% accurate in predicting nonorgan-confined bladder disease before cystectomy. Further external validation in a large cohort was recommended as still necessary.
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Affiliation(s)
- David Margel
- Institute of Urology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
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Stec AA, Cookson MS, Chang SS. Detection of Extravesical Disease: A Lack of Bladder Cancer Markers. Bladder Cancer 2009. [DOI: 10.1007/978-1-59745-417-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bastos Oreiro M, López Rodríguez M, Monedero Martín MC, Plasencia Rodríguez C. [Elevation of CA 19.9 in urothelial bladder cancer]. Med Clin (Barc) 2008; 130:319. [PMID: 18358126 DOI: 10.1157/13116588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Serum Tumor Markers May Predict Overall and Disease Specific Survival in Patients With Clinically Organ Confined Invasive Bladder Cancer. J Urol 2007; 178:2297-300; discussion 2300-1. [DOI: 10.1016/j.juro.2007.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Indexed: 11/17/2022]
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Lerner SP, Bochner B, Kibel AS. The use and abuse of data: nomograms and talking to patients about clinical medicine. Urol Oncol 2007; 25:333-7. [PMID: 17628303 DOI: 10.1016/j.urolonc.2007.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the development of nomograms and consortia efforts applying these tools to model outcome predictions associated with radical cystectomy. FINDINGS Nomograms have been developed that provide individualized prediction of recurrence and survival following radical cystectomy, which provide significant improvement in predictive accuracy over tradition TNM staging. CONCLUSIONS Nomograms provide individualized risk assessment and outperform expert physician and conventional models used to predict outcome. Addition of biologic markers may improve predictive capability and improve the clinical utility of these valuable tools.
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Affiliation(s)
- Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA.
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