SERUM TISSUE POLYPEPTIDE ANTIGEN IN BLADDER-CANCER AS A TUMOR-MARKER - A PROSPECTIVE-STUDY

Purpose: Tissue polypeptide antigen (TPA) is ct differentiation and pr oliferation tissue marker of epithelia. Increased serum levels were fo und in some patients with invasive bladder cancer. We present the resu lts of a prospective study that evaluated the role of serum TPA (S-TPA ) in bladder carcinoma. Patients and Methods: The series included 167 patients treated for bladder cancer between 1989 and 1996. S-TPA conce ntrations were measured by radioimmunoassay before treatment, at the e nd of treatment and during follow-up evaluation. The upper normal limi t of the test was set at 80 Ul/L. Results: With a specificity of 100%, the diagnostic sensitivity was 46%. Pretherapeutic S-TPA levels were significantly correlated with tumor stage (T2 v T3 and T4; P=.02), wit h nodal stage (N0 v N1 and N2; P=.00001), and with metastatic stage (M O vM1; P = 10(-6)), but not with histologic grading (grade 1 and 2 v 3 ). In the subset of patients with normal pretherapeutic S-TPA levels, 95% had no residual disease at the end of treatment, compared with 53% of patients with initial elevated S-TPA (P = 10(-8)). Among patients who achieved a complete response, 27% experienced a relapse, with an i ncrease of S-TPA in 72% of cases, The mean follow-up time was 20 +/- 1 7 months. For patients with normal pretherapeutic S-TPA levels, 3-year overall survival and disease-free survival rates were 76% and 67% res pectively. These were 46% (P = .001) and 25% (P = 10(-7)), respectivel y, for patients with high pretherapeutic S-TPA. Multivariate analysis showed that S-TPA was an independant prognostic factor for survival [P = .03). Conclusion: In invasive bladder cancer, S-TPA level is correl ated with initial tumor stage. It is a valuable parameter for follow-u p evaluation and appears to be a prognostic factor in multivariate ana lysis. (C) 1997 by American Society of Clinical Oncology.