CA19.9 and CEA in Transitional Cell Carcinoma of the Bladder: Serological and Immunohistochemical Findings

Background: Reliable blood and urine markers for transitional cell carcinoma of the bladder (TCC) do not currently exist. The aim of this prospective study was the serological and immunohistochemical evaluation of CA19.9 and CEA in TCC and to assess the correlation with different TCC stages. Patients and Methods: CA19.9 and CEA levels were prospectively determined in samples from 231 patients with TCC suspected bladder lesions, before transurethral tumor resection. Additionally, these serum parameters were determined in 11 patients with initial metastatic TCC. Immunohistochemical analysis on CA19.9 and CEA was performed in 83 patients. Results: Neither CA19.9 nor CEA levels were significantly elevated in TCC patients. Patients with muscle-invasive TCC showed significantly higher levels of CEA (p=0.008) and CA19.9 (p<0.001) compared to those with superficial TCC. Significantly higher levels were also evident with increasing grade of malignancy. Metastatic TCC showed significantly elevated CA19.9 levels compared to muscle invasive TCC as well as locally advanced (pT3/pT4/pN+) compared to localized TCC (pT2/pN0). Immunohistochemical staining revealed a strong correlation between CA19.9 serum levels and staining intensity. Conclusion: CEA and CA19.9 are not useful markers in primary diagnosis of TCC. However, in instances of elevated CEA and CA19.9 levels where gastrointestinal malignancy has been excluded, evidence of TCC should be sought. If elevated CEA and CA19.9 are present in TCC, serum levels correlate with tumor invasion and grade of malignancy.