SERUM TISSUE POLYPEPTIDE ANTIGEN (S-TPA) IN BLADDER-CANCER AS A TUMOR-MARKER - A PROSPECTIVE-STUDY

Background. Tissue polypeptide antigen (TPA) is a differentiation and a proliferation tissue marker of nonsquamous epithelia. Increased urin ary and serum TPA (S-TPA) levels were found in some patients with inva sive bladder cancer. The authors report the results of a prospective s tudy evaluating the role of serum TPA (S-TPA) in bladder carcinoma. Me thods, S-TPA concentrations were measured by radioimmunoassay in 53 pa tients with invasive bladder tumor before treatment, at the end of tre atment, and during follow-up. The upper normal limit of the test was s et at 80 UI/ml. Results. With a specificity of 100%, the diagnostic se nsitivity of the test was 54.7%. S-TPA was increased in 88% of patient s with N1 + N2 disease compared with 38.8% of the patients with N0 dis ease (P = 0.01) and in 100% of patients with metastatic disease and 48 % of patients with nonmetastatic disease (P = 0.01). S-TPA was increas ed in 23% of patients with total macroscopic debulking and in 68% of p atients with persistent macroscopic disease (P = 0.004). For patients staged N0 M0, no statistical correlation between S-TPA level and debul king by transurethral resection (TUR) was found (P = 0.15). In the sub set of patients with normal pretherapeutic S-TPA levels, 75% achieved a complete response, compared with 44.8% of the patients with initial elevated S-TPA levels (P = 0.04). However, there was no statistically significant relationship between pretherapeutic S-TPA levels and immed iate response to treatment according to the stratification for tumor v olume after initial debulking by TUR. For a mean follow-up of 15 month s +/- 7 months, median survival time and 1-year survival rates were st udied in the subset of patients with limited disease (N0 M0) according to the pretherapeutic S-TPA levels. The median survival time was not reached, and the 1-year survival rate was 80% when the initial S-TPA l evel was normal; these were 10 months and 44%, respectively, when the S-TPA level was high (P < 0.01). Among the 31 patients who achieved a complete response, 9 experienced a relapse, with an increase of the S- TPA level in 8 patients. Conclusions. The S-TPA level is correlated wi th initial tumor volume. It appears to be a prognostic factor and a va luable parameter for follow-up.