Purpose: We evaluated the role of CA 125 as a prognostic marker in patients with transitional cell carcinoma (TCC) of the bladder undergoing uniform radical cystectomy with bilateral pelvic iliac lymphadenectomy.
Materials and methods: From April 1996 to March 2001, 287 patients with a median age of 68 years (range 34 to 89) had preoperative CA 125 serum assays performed. All patients had high grade or invasive TCC and were scheduled to undergo radical cystectomy. Preoperative CA 125 was evaluated according to tumor grade and pathological subgroups (organ confined, extravesical and lymph node positive) as well as recurrence-free and overall survival.
Results: Of the 287 patients 31 (10.8%) demonstrated increased serum CA 125 (greater than 35 U/ml). No significant association was found between increased CA 125 and recurrence-free survival or tumor grade. However, a statistically significant association was found among pathological tumor subgroups, namely 4.9% for organ confined, 11.3% for extravesical and 21.6% for lymph node positive disease (p <0.001). Furthermore, patients with lymph node positive disease or high grade tumors (grades III/IV and IV/IV) and increased CA 125 assays demonstrated significantly worse overall survival (p <0.001).
Conclusions: Increased CA 125 was seen in approximately 11% of patients with high grade or invasive TCC preoperatively. It was more commonly found in patients with locally advanced and lymph node positive disease, and it was associated with overall survival. However, recurrence-free survival was not associated with CA 125. Further studies are required to define the exact role of CA 125 in bladder cancer.