Tumor Markers (CEA, TPA and CA 19–9) in Urine of Bladder Cancer Patients

This study was carried out to evaluate the usefulness of determining urinary levels of carcinoembryogenic antigen (CEA), tissue-polypeptide antigen (TPA), and gastrointestinal cancer antigen (Cal 9-9) in addition to the usual diagnostic procedures for bladder cancer. Sixty-seven patients with transitional bladder cancer, 40 healthy controls and 20 patients with inflammatory diseases of the urinary tract were considered. All urine samples were obtained from patients with intact renal function and no urinary tract infection. TPA and Cal 9-9 urinary levels in patients with G3 bladder tumors were significantly higher than in those with lower graded neoplasms. The sensitivity, specificity, and predictive value of a positive (PV+) or negative (PV–) test and the diagnostic accuracy were also evaluated. Cal 9-9 was the best urinary marker for bladder cancer (sensitivity 71.6%, specificity 91.6%, PV + 90.5%, PV–74.3%, diagnostic accuracy 81%).

Simultaneous Determination of Urinary CEA, Ferritin and TPA in Egyptian Bladder Cancer Patients

Urinary carcinoembryonic antigen (CEA), ferritin (Fer) and tissue polypeptide antigen (TPA) were determined in 328 cases (106 with blader cancer, 152 with non-malignant urinary tract disease and 70 healthy controls). CEA was determined by the kit supplied by Roche Diagnostica (CEA EIA Doumab 60), ferritin by the Tandem-E Fer kit supplied by Hybritech and TPA by the Prolifigen TPA-IRMA kit supplied by Sangtec Medical. The results of this work revealed that combined determination of urine CEA and Fer, CEA and TPA or Fer and TPA showed higher sensitivity than determination of the individual markers. There was no significant difference between combined and individual marker determination with respect to false positivity in non-malignant urinary tract diseases. At 97% specificity, the sensitivities of urine CEA, Fer and TPA were 82.1%,71.7% and 90.6%, respectively, while combined urine CEA & Fer, CEA & TPA and Fer & TPA showed sensitivities of 92.5%, 99.1% and 98.1%, respectively. When the specificity was related to the entire non-cancer group (patients with benign urinary tract diseases and normal controls), some reduction in the sensitivities of the combined markers was noted compared to the normal group only.

In conclusion, combined determination of urine markers is superior to determination of individual markers in the diagnosis of bladder cancer

Cathepsin D and carcino-embryonic antigen in serum, urine and tissues of colon adenocarcinoma patients

BACKGROUND/AIMS

Application of neoplastic markers in early diagnosis of colorectal carcinoma has brought fresh hope to millions of sufferers. However such a marker, distinctive for this particular carcinoma and allowing its detection at a sufficiently early stage of development has not yet been found. Cathepsin D (CD) is lysosomal aspartyl proteinase. It is a component of a proteolytic cascade participating actively in neoplastic invasion as well as in metastasis formation. Carcino-embryonic antigen (CEA) is a useful marker in oncological diagnostics of colorectal cancer. CEA undergoes expression in all kinds of adenocarcinoma and is found both intercellularly and extracellularly. High concentrations of CEA in the blood serum confirm neoplastic changes in the digestive tract with high probability. The objective of this study has been to evaluate CD activity in the blood serum, urine and tumor tissues as well as in the colon biopsies which were not changed macroscopically and CEA concentration in the serum of colon adenocarcinoma, considering the extent of spread of cancer (TNM), the grade of the differentiation of cancer cell (G) as well as the tumor size. The possibility of application of CD along with CEA as markers of colon adenocarcinoma has also been examined.

METHODOLOGY

The examination included the serum and urine of 21 patients as well as 12 tissues biopsies with histopathologically confirmed colon adenocarcinoma. The reference group for the blood and urine comprised of 17 healthy controls, and for the colon adenocarcinoma tissues- samples collected from 14 people from the sites most distant from the resected tumor on the boundaries which were free of cancer cells. Activity of CD in the blood serum, urine as well as tissues was determined with a modified Greczaniuk et al. method and expressed by the amount of released tyrosine as the concentration of the activity in nmolTyr/mL/6h, whereas the specific activity was expressed in nmol Tyr/mg of protein /6h. The specific activity of CD in the urine was expressed in nmol Tyr/mg of creatinine/6h. CEA concentration in the blood serum was determined by the immunoenzymatic method (MEIA) on Axym Abbot Analyzer and was expressed in ng/mL. The protein concentration was determined by the Lowry method, and the results were expressed in mg/mL. The creatinine concentration in the urine was determined by the Jaffe method (without deproteinization) and was expressed in mg/100mL.

RESULTS

CD activity was increased in the blood serum (p < 0.0001) and tissues (p = 0.022) of colon adenocarcinoma patients in comparison to the reference group. CD specific activity (Tyr/mg of protein/6h) was significantly increased in serum but decreased in the urine (p < 0.0001) whereas the specific activity of CD (nmol Tyr/mg of creatinine/6h) was increased in the urine (p = 0.0001). CD specific activity has tendency to increase in colon adenocarcinoma tissues (p = 0.441) as compared to the reference group. By examining data in regard to TNM clinical-histopathological classification, G and the tumor size, it could be concluded that CD activity in serum and urine in colon adenocarcinoma patients depends on progress of cancer in which CD activity increases with TNM. A statistically significant increase in CEA concentration was found in the serum of colon adenocarcinoma patients, which was almost threefold higher than the in reference group. No significant differences in CEA concentration were found depending on TNM, G and tumor size.

CONCLUSIONS

The results of this study suggest that examination of CD activity and CEA concentration in serum, as well as CD activity in the urine, might be used in oncological diagnostics of colon adenocarcinoma.

Utility of slot-blot-ELISA as a new, fast, and sensitive immunoassay for detection of carcinoembryonic antigen in the urine samples of patients with various gastrointestinal malignancies

Carcinoembryonic antigen (CEA) is the most widely used clinical tumor marker. CEA immunoassay has found acceptance as a diagnostic adjunct in clinical diagnosis of gastrointestinal tumors (GIT). Several immunoassays have been established for detection of CEA in plasma, serum, tissue, feces, and urine of cancer patients using polyclonal or monoclonal antibodies raised against CEA. Some of these assays display both high sensitivity and specificity for the detection of CEA. However, these assays require special and highly expensive equipment and the procedures require long periods for their completion. In the present study, we established a Slot-Blot Enzyme Linked Immunosorbent Assay (SB-ELISA), based on anti-CEA monoclonal antibody (CEA-mAb), as a new, simple, fast, cheap, and non-invasive immunodiagnostic technique for detection of CEA in the urine of GIT patients. Urine and serum samples were collected from 248 GIT patients (58 with pancreatic cancer, 20 with hepatoma, 23 with ampullary carcinoma, 15 with hilar cholangiocarcinoma, 28 with gastric cancer, 14 with esophageal cancer, and 90 with colorectal cancer). Moreover, urine and serum samples were collected from 50 healthy individuals to serve as negative controls. The traditional ELISA technique was used for determination of CEA in the sera of GIT patients using anti-CEA monoclonal antibody. A comparison between the results of both techniques (ELISA and SB-ELISA) was carried out. The traditional ELISA detected CEA in the sera of 154 out of 248 GIT patients with a sensitivity of 59.8%, 51.7% positive predictive value (PPV) and 75.37% negative predictive value (NPV). In addition, it identified 15 false positive cases out of 50 healthy individuals with a specificity of 70%. The urinary CEA was identified by a Western blotting technique and CEA-mAb at a molecular mass of 180 Kda. The developed SB-ELISA showed higher sensitivity, specificity, PPV, and NPV (70.1%, 78%, 62.4%, and 82.13%, respectively) for detection of CEA in the urine of GIT patients. The semi-quantitative SB-ELISA showed a higher overall efficiency of 72.8% versus 63.4% in the case of the quantitative ELISA, for detection of CEA. In conclusion, SB-ELISA is more efficient for detection of CEA in gastrointestinal tumors. It is a simple, rapid, non-invasive, and sensitive assay. Moreover, all steps of the SB-ELISA are performed at room temperature, without the use of expensive equipment; this may enhance the application of this assay in field studies and mass screening programs.

Urine carcinoembryonic antigen levels are more useful than serum levels for early detection of Bilharzial and non-Bilharzial urinary bladder carcinoma: observations of 43 Egyptian cases

Background

Both urinary bilharziasis and urothelial neoplasia are associated with increased production of tissue carcinoembryonic antigen (CEA).

Patients and methods

Urine and serum CEA were determined in 43 patients with urinary bladder carcinoma including 22 post bilharzial and 21 nonbiharzial cases, in addition to 10 normal control cases.

Results

A significant increase was detected in both urine and serum CEA levels with bladder carcinoma compared to control cases. Urinary CEA was significantly elevated in 86% of bilharzial, versus 62% in nonbilharzial bladder carcinoma. Only 10.5% of control cases had urinary CEA elevation. The mean urinary CEA in bilharzial, was higher than that of nonbilharzial carcinoma, but the difference was not statistically significant. There was a definite relationship between urine CEA and the stage of malignancy; the higher the stage, the higher the level of urine CEA. No relationship could be detected between the stage of malignancy and serum CEA, or between the grades of malignancy and urine or serum CEA levels.

Conclusion

Urinary CEA is more useful than serum CEA in the early detection of urotherlial carcinoma particularly if provoked by bilharziasis. Its level is also correlated with the tumor stage.

ImmunoCyt/uCyt+ improves the sensitivity of urine cytology in patients followed for urothelial carcinoma

ImmunoCyt/uCyt is a fluorescent test combining three monoclonal antibodies. In this study, it has been tested as a complement to cytology in the detection of urothelial carcinoma in urine. It has been performed simultaneously with standard cytology and cystoscopy on 870 urine analyses from one hospital. In 136 cases, one or more bladder tumors were found. Overall sensitivity of cytology, ImmunoCyt/uCyt and combined analyses reached 29, 74 and 84%, respectively, and overall specificity was 98, 62 and 61%. The negative predictive value of cytology, ImmunoCyt/uCyt and both analyses was 88, 93 and 95%, respectively, and the positive predictive value was 70, 26 and 29%. The sensitivity of cytology for low malignant potential neoplasms, low- and high-grade papillary carcinomas was 6, 18 and 53%, while it reached 71, 79 and 93% when combined with ImmunoCyt/uCyt. The sensitivity of cytology for stages Ta, T1, T2 and over and Tis tumors was 12, 67, 47 and 50%, while it reached 78, 83, 79 and 100% when combined with ImmunoCyt/uCyt. In the absence of tumor on cystoscopy but with positive ImmunoCyt/uCyt, 18% of patients developed a tumor, 2-6 months later. Of the 109 cases diagnosed as suspicious for malignancy by cytology, a tumor was present in 30 cases and ImmunoCyt/uCyt was positive in 22 (73%) of them. In conclusion, ImmunoCyt/uCyt may be used to postpone cystoscopies in patients followed for bladder cancer and may help to save cytologist and pathologist screening time.

[ImmunoCyt--a new urine test in diagnosis of bladder cancer]

ImmunoCyt is a new immunocytologic fluorescence test promising a higher diagnostic sensitivity, esp. for TaG1 carcinomas. The aim of the study was to evaluate the sensitivity of the test in diagnosis of bladder cancer as compared to both urinary cytology and histopathology. A total of 121 spontaneous urine samples of 92 patients (age range 28 to 86, mean 62.5 years) was examined. 41 of the samples were of patients suspicious of transitional cell carcinoma, 46 of patients in whom symptoms were suggestive of tumor recurrence, and 34 of patients who were part of a follow-up protocol. Cystoscopy was performed in all patients. The ImmunoCyt-test was carried out according to the manufacturers protocol using 3 fluorescent monoclonal antibodies. A total of 113 specimens could be evaluated. In 87 cystoscopy and/or histology was negative (control group). There was histologic evidence of 7 pTaG1, 4 pTaG2, 8 pT1G2/G3, and 7 pT2G2/G3 bladder cancers. As for ImmunoCyt and cytology specificity was 83.9% and 91.9%, resp. The combined specificity was 81.6%. Sensitivity amounted to 38.5% and 34.6%, resp., the combined sensitivity to 53.8%. Sensitivity for TaG1 carcinomas was 14.3% each, for TaG2 carcinomas 25% and 50%, for T1G2/G3 carcinomas 37.5% each, and for T2G2/G3 carcinomas 71.4% and 42.9%, resp. In our study the ImmunoCyt test did not show the expected increase in the detection of TaG1 bladder cancers. Because of false-positive results the test should only be used in combination with urinary cytology which reveals a higher specificity. In conclusion the ImmunoCyt test can not replace cystoscopy (with biopsy) in diagnosis and monitoring of bladder cancer.

Immunocyt test improves the diagnostic accuracy of urinary cytology: results of a French multicenter study

PURPOSE

The limitations of urinary cytology and the invasiveness of cystoscopy generate an increasing interest in noninvasive diagnostic tools for the management of transitional cell carcinoma. We assess the clinical performance of ImmunoCyt (DiagnoCure, Inc., Saint-Foy, Canada) in the detection of bladder cancer in a 10-center French trial.

MATERIALS AND METHODS

From October 2000 to April 2001, 694 patients undergoing cystoscopy were prospectively included in the study. Of the patients 458 (66%) had been previously treated for superficial transitional cell carcinoma and 236 (34%) were referred for symptoms suggestive of bladder cancer. All patients underwent ImmunoCyt test and standard urinary cytology from voided urine as well as a complete evaluation including cystoscopy and transurethral resection or biopsy of suspicious lesions. Sensitivity and specificity values of urinary cytology and ImmunoCyt whether or not combined were calculated using cystoscopy as the gold standard and histopathology when available.

RESULTS

A total of 85 recurrent and 58 newly diagnosed bladder tumors were diagnosed by cystoscopy and histologicaly confirmed. Overall sensitivity of urinary cytology was 17.9%, 46.3% and 63.8% respectively, for G1, G2 and G3 transitional cell carcinoma, whereas that of ImmunoCyt was 60.7%, 75.6% and 76.8%. Sensitivity of the combined tests was 66.7%, 78% and 87%, respectively. Moreover, 10 of 55 (18.2%) new pT1 and pT2 or greater tumors were diagnosed by ImmunoCyt alone. Specificity of urinary cytology was 94.5%, whereas that of ImmunoCyt was 84.2%. Specificity of the combined tests was 80.7%. Marked variations in urinary cytology sensitivity were observed among the different centers (27.3% to 66.7%), whereas combined assays (urinary cytology and ImmunoCyt) enhanced the overall sensitivity in the 80% range at most centers.

CONCLUSIONS

This prospective multicenter series confirmed a marked increase in sensitivity without significant loss in specificity when including ImmunoCyt in standard urinary cytology protocol. This increased sensitivity was observed in high grade lesions (with 100% sensitivity for carcinoma in situ) as well in low grade, low stage tumors.

Accuracy of the ImmunoCyt assay in the diagnosis of transitional cell carcinoma of the urinary bladder

The ImmunoCyt assay (Diagnocure Inc., Québec, Canada) is a new immunocytological fluorescence test for identifying two different mucins and a high-molecular-weight glycosylated carcinoembryonic antigen (CEA) present in tumours originating from transitional epithelial cells. The test promises a higher diagnostic sensitivity in transitional cell carcinoma (TCC) of the bladder than voided urine cytology. Our study was designed to evaluate this test especially for TaG1 carcinomas, which are characterised by a low detection rate in urinary cytology. A total of 121 spontaneous urine samples of 92 patients (age range 28 to 86, mean 62.5 years) were examined. The samples were taken from patients suspected of having TCC (41 out of 121) or tumor recurrence (46 out of 121), or who were part of a follow-up protocol (34 out of 121). Cystoscopy was practiced in all patients. The ImmunoCyt test was carried out according to the manufacturer's protocol. For cytology cytospins were made from the same urine samples and stained according to the method of Papanicolaou. One hundred and thirteen specimens could be evaluated. In 87 cystoscopy and/or histology were negative. There was histological evidence of 7 pTaG1, 4 pTaG2, 8 pT1G2/G3 and 7 pT2G2/G3 TCC. As for ImmunoCyt and cytology, specificity was 83.9% and 91.9%, respectively. A combination of either test indicated 81.6% specificity. The sensitivity amounted to 38.5% and 34.6%, respectively, and the combined sensitivity to 53.8%. The sensitivity for TaG1 carcinomas was 14.3% each, for TaG2 carcinomas 25% and 50%, for T1G2/G3 carcinomas it amounted to 37.5% each, while for T2G2/G3 carcinomas it was 71.4% and 42.9%, respectively. The higher sensitivity of the ImmunoCyt test as compared to urinary cytology renders improved identification of exfoliated tumour cells in bladder cancer possible. In our study, however, the expected increase in detecting TaG1 carcinomas was not found. Because of its lower specificity, the test should only be used in combination with voided urine cytology. On account of its low sensitivity, the ImmunoCyt test cannot replace cystoscopy (with biopsy) in the diagnosis and monitoring of bladder cancer.

Increased serum carcinoembryonic antigen level in patients undergoing colon neobladder replacement compared with ileal neobladder replacement

OBJECTIVES

To compare the serum and urinary carcinoembryonic antigen (CEA) levels for assessment of possible risk of malignant transformation in patients with orthotopic neobladder.

METHODS

The serum and urinary levels of CEA, nutritional status, and acid-base and electrolyte balances were studied in 87 patients after radical cystectomy (22 with ileal neobladder, 28 with colon neobladder, and 37 with ileal conduit). The results of these groups were compared.

RESULTS

The serum CEA level in patients with colon neobladder, ileal neobladder, and ileal conduit was 5.4 +/- 3.0, 3.7 +/- 1.6, and 3.1 +/- 1.5 ng/mL, respectively. The serum CEA level in the colon neobladder group was significantly higher than the levels in the remaining two groups (P <0.05); 16 patients (57%) with colon neobladder had elevated serum CEA values (ie, greater than 5 mg/mL). Elevated serum CEA was observed in only 5 (23%) and 3 (8%) patients with ileal neobladder or ileal conduit, respectively. The serum CEA value in these patients was associated with the urinary CEA value (P <0.001), but not the other factors examined.

CONCLUSIONS

These findings suggest that colon bladder replacement caused significantly increased serum CEA values compared with ileal neobladder or ileal conduit; however, the elevated serum CEA level correlated with the urinary CEA level, irrespective of other clinical factors. Therefore, the elevated serum CEA in the colon neobladder group may have been due to reabsorption of CEA in urine rather than to an association with malignant changes in the bowel segments used for neobladder creation.

Elevated tumour markers in patients with Balkan endemic nephropathy

Balkan nephropathy (BEN) is commonly associated with urothelial cancer. Urothelial cancer is manifested in the advanced stage of disease. The aim of this study was to facilitate early detection of urothelial cancer in BEN patients and their family members living in an endemic region by using tumour markers, carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA), and a putative marker, ferritin. Fifteen BEN patients with normal renal function, 17 with renal failure (BEN-RF), 13 healthy members of their families (HFM), 14 patients with glomerulonephritis (GN) and 12 healthy controls (C) were studied. Serum CEA levels in BEN patients were within normal limits, however, in BEN-RF patients they were significantly increased over HFM (p<0.05). Serum TPA levels in BEN and BEN-RF patients were significantly higher than in the C and HFM groups (p<0.05). Urinary CEA was not significantly different between the groups studied. Urinary TPA levels in HFM (median 125 U/l, BEN (236 U/l) and BEN-RF (275 U/l) were significantly increased over C (30 U/l), however, TPA levels were increased also in GN patients (437 U/l). None of the BEN patients studied developed urothelial cancer during the ten years' follow-up. Markedly elevated urinary TPA-like levels in all patients studied (HFM, BEN, BEN-RF, GN) suggest that urinary TPA may not be a reliable tumour marker. However, the clinical relevance of high TPA levels in BEN patients should be evaluated.

Carcinoembryonic antigen-related cell-cell adhesion molecule C-CAM is greatly increased in serum and urine of rats with liver diseases

C-CAM (rat cell CAM/human CD66a) is ubiquitous and multifunctional. It is involved in intercellular adhesion, signal transduction and cell growth inhibition. Structurally, it is related to the carcinoembryonic antigen. In the present study serum, bile and urine of rats with liver diseases were analyzed for the presence of cell CAM. After bile duct ligation and during galactosamine (GalN) hepatitis we found that large amounts of liver membrane-bound C-CAM are secreted or shed into blood. The serum level of another liver membrane-bound protein, LI-cadherin, is not increased. It was shown that C-CAM is also present in bile fluid, and for the first time that C-CAM is present in the urine of rats with liver diseases. A particularly high concentration was measured in the urine of rats suffering from GalN hepatitis.

Cancer marker assessment: case report on salivary and urinary CEA

A circadian rhythm is demonstrated for salivary CEA in a clinically healthy man who collected unstimulated saliva samples around the clock for 4 days. Its acrophase occurs around 07:00, slightly later than for patients with colon cancer. A circadian rhythm of borderline statistical significance is found for the urinary excretion rate of CEA determined during the same span by this patient. It has an acrophase occurring around 15:00, differing from that of salivary CEA. Although CEA may have only limited value to assess tumor burden, even when determined in blood, rhythm characteristics of tumor markers such as CEA await applications for guiding treatment timing and for detecting earliest chronome alterations not only in the case of an overt cancer but as a feature of predisease and/or disease risk elevation.

Immunocytochemically demonstrated expression of epithelial membrane antigen and carcinoembryonic antigen by exfoliated urinary cells in patients with bladder cancer

The localization of epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) in exfoliated cells from voided urine was examined to clarify whether immunostaining for these markers is more useful than conventional cytology for diagnosis of patients with transitional cell carcinoma of the bladder. Both EMA and CEA were present more frequently in specimens from higher-grade and higher-stage tumors than lower-grade and lower-stage tumors. Cells positive for one or both of these markers were also found in specimens from cancer patients with only suspicious results by conventional cytology. In grade 1 tumors, the positive rates were 50% for EMA staining and 40% for CEA staining compared with 10% for conventional cytology. In 12 patients with cystitis, results for EMA staining and conventional cytology were all negative, whereas CEA staining proved positive in 6 patients (50%). None of 10 normal subjects with conventional cytology had positive results for EMA or CEA staining. These findings indicate that immunocytochemistry for EMA is a more useful adjunctive method than CEA staining or conventional cytology for detection of tumor cells, especially in cases of low-grade bladder cancer.

Urinary levels of tumour associated antigens (CA 19-9, TPA and CEA) in patients with neoplastic and non-neoplastic urothelial abnormalities

The urinary excretion of carbohydrate antigen 19-9 (CA 19-9), tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA) was evaluated in 264 patients with bladder cancer. Cut-off levels were established using a pool of healthy blood donors. The combined determination of CA 19-9 and TPA had a sensitivity of 74% in pTa and 83% in pT1 tumours, and 62% in grade 1, well differentiated tumours. Absence of disease at follow-up was related to a significant decrease in CA 19-9 and TPA in 129 patients with superficial (pTa or pT1) bladder carcinoma, followed up for at least 3 years. Recurrences, defined as new tumours at the same site or elsewhere in the bladder, were associated with an increase in the mean values but this was not statistically significant. A poor prognosis was indicated in patients with infiltrating tumours and the following pre-operative levels: TPA > 1500 u/l or CA 19-9 > 300 u/ml or CEA > 50 ng/ml.

[Immunological and biochemical characterization of urinary carcinoembryonic antigen and its clinical significance]

The immunobiochemical properties of urinary carcinoembryonic antigen (U-CEA) purified from non-tumor-bearing patients with urinary tract infection were investigated. Moreover, immunohistochemical localization of CEA in the normal urothelium was studied and clinical significance of U-CEA was also analyzed statistically. The purified U-CEA showed a molecular weight of approximately 160,000 by the Western blotting and an antigenicity identical to the purified CEA (Calbiochem Corp.). Amino acids analysis of U-CEA revealed nearly the same values as the purified CEA or the theoretical values of CEA, except for several amino acids susceptible to hydrolysis and sugar chains. Therefore, it was assumed that the U-CEA was a new CEA-related antigen, different from nonspecific cross-reacting antigen (NCA) or even CEA itself. Immunohistochemically, CEA was found mainly at the cytoplasmic membrane in normal urothelial cells. The urine samples, collected from patients with various urological disorders, were divided into the inflammation group, showing 5 leukocytes/hpf or more in the urine, and the non-inflammation group, showing less than 5 leukocytes/hpf. The groups were subdivided and U-CEA levels were statistically studied; it was found that the U-CEA levels strongly reflected the presence of inflammation, rather than the presence of urothelial tumors. Consequently, it was considered that CEA was present in the normal urothelium and that destruction and regeneration of these cells due to tumor or inflammation might release CEA, not NCA, into the urine.

Urinary fibronectin fragments (a potential tumor marker) measured by immunoenzymometric assay with domain-specific monoclonal antibodies

We found that urinary fibronectin (UFN) in cancer patients was almost all fragmented and consisted mainly of the cell-binding domain. We developed a two-site immunoenzymometric assay for UFN, using two monoclonal antibodies that both recognize this domain of fibronectin. The amount of UFN was expressed as arbitrary units per milligram of creatinine. Some 2% of the 623 healthy subjects had UFN above the clinical cutoff point (200 arb. units/mg creatinine), as did 14% of the 271 patients with nonmalignant diseases. In contrast, concentrations of UFN exceeded the cutoff point in 59% of the 589 patients with cancer. In 37 patients with gastrointestinal cancer tested for UFN and for one or more of three established serum tumor markers, UFN was found in 25, significantly more often than the other markers. These results indicated that UFN is a marker that may be helpful in evaluating many kinds of cancer.

[Blood and urinary values of CEA and CA 19-9 in patients with bladder carcinoma]

Carcinoembryonic antigen (CEA) and Ca 19-9 levels in urine and serum from 46 patients with bladder cancer in varying stages have been evaluated. All samples of urine were obtained germ-free and without bacterial infection in the bladder. The sensitivity of CEA monoclonal antibody is 60.8% and specificity is 80%. Ca 19-9 test has higher sensitivity (74%) and the same specificity. Correlation between staging, grading and CEA or Ca 19-9 values were also evaluated.

Evaluation of a double-monoclonal radioimmunoassay for the measurement of carcinoembryonic antigen in the urine of patients with bladder cancer

A double-monoclonal radioimmunoassay (RIA) has been used to detect urinary carcinoembryonic antigen (CEA) in 204 patients attending for diagnostic cystoscopy. Elevated levels of urinary CEA were found in 50% of patients with bladder tumours, and these levels correlated with both the grade and stage of the tumour. The sensitivity proved to be 58% and the specificity 74%, which compares with previous studies using polyclonal RIA kits. As a monitoring test, urinary CEA proves to be as useful as urine cytology. The use of a more specific assay does not increase the clinical value of the test which still lacks the sensitivity and specificity needed to allow it to be used to monitor recurrence of low grade tumours (Ta, Tis and T1).

[Clinicopathological study of urinary bladder tumors. Clinical evaluation of immunohistochemistry in urine cytology]

We report on the immunohistochemical detection of carcinoembryonic antigen in the urine cytology of 5 patients with urinary bladder tumors classified as low, moderate, and high grade. Immunohistochemically carcinoembryonic antigens were detected in urine cytology in the case of moderate and high grade tumors, but not, low grade tumors. Carcinoembryonic antigen positivity in urine cytology correlated with the histological grade of a bladder tumor. Carcinoembryonic antigen in urine cytology seemed to be a potentially good marker to distinguish between high grade and low grade tumors.

Possibilities for an extended classification of bladder cancer

Patients with bladder cancer were evaluated for T-class, histo-pathological grade and U-CEA (urinary carcinoembryonic antigen) before treatment and the cytological picture 4 months after treatment. Previous work has shown that these variables are not significantly intercorrelated. Scores were computed, consisting of the sums of these (dichotomized) variables. In a statistical analysis with the life-table technique, the scored variables have been log-rank tested for a prognostic trend. In 155 patients, p for symptom-free survival between subgroups with low and high scores was 0.0019 and for relative survival 0.0005. This implies that a combination of variables may have predictive value in bladder cancer.

Short-term prognosis of bladder cancer. Evaluation with urinary CEA

The parameters U-CEA and stage (T) appear to be good predictors of survival in bladder carcinoma during the first 12 months after diagnosis; calculated with the Cox regression model in a multivariate way. Calculated separately in a bivariate manner 0-12 months after diagnosis, U-CEA and T were highly significant predictors for survival. G did not add to the predictors for survival. Grade (G) did not add to the predictive power during the first 12 months but became more informative a year and later after diagnosis.

Beta2-microglobulin, carcinoembryonic antigen and prostatic acid phosphatase in split ejaculates and urine voided before and after massage of the prostate

Analyses of split ejaculates and urine voided before and after prostatic massage have been used to evaluate the origin of beta2-microglobulin (b2m) and carcinoembryonic antigen (CEA) in human semen. CEA and b2m were present in rather high concentrations in all the fractions of the split ejaculates. The urine voided after massage of the prostate also contained increased levels of CEA and beta2-microglobulin. Split ejaculates, selected from the electrophoretic pattern obtained for each fraction, revealed that b2m in seminal plasma originates from the prostate and seminal vesicles in equal amounts. Besides the "free" b2m in seminal plasma, human semen contains a sperm-bound b2m fraction. Carcinoembryonic antigen was found in the highest concentrations in the second fraction of split ejaculates indicating that it originates mainly from the prostate.

[Determination of carcinoembryonic antigen in urine and in gastric secretions]

The diagnostic significance of the identification of carcinoembryonic antigens in the serum, urine and gastric secretions of patients with malignant neoplasms is considered. In the subjects tested, CEA levels in the serum and gastric secretion were certainly diagnostically indicative. Increases in urinary CEA levels were however minimal, even lower than those encountered during urinary inflammations.

Urinary carcinoembryogenic antigen (CEA) in the diagnosis and follow-up of bladder carcinoma

The level of urinary carcinoembryogenic antigen (CEA) was evaluated in the diagnosis and follow-up of urothelial carcinoma of the bladder. Urinary CEA concentration, cystoscopic findings and the histopathology of an eventually resected bladder tumour were correlated in 177 cases. The sensitivity proved to be 34%, the specificity 82%. Possible correlations with sex, infection, primary tumour or recurrence, differentiation and invasion of an eventually resected tumour and influence of adjuvant therapy were also evaluated. A comparison was made with the results of other authors and different factors which may influence urinary CEA levels are discussed.

[Assessment of urinary ferritin, CEA and beta 2-MG determinations in patients with urinary tract malignancies]

Ferritin, carcinoembryonic antigen (CEA) and beta 2-microglobulin (beta 2-MG) levels in urine from 45 patients with cancer (4 with renal adenocarcinoma, 7 with renal pelvic and ureteral cancer and 34 with bladder cancer) at various stages were clinically evaluated for their significance as parameter of urinary tract malignancies as compared to urinary fibrin/fibrinogen degradation products (FDP) and urine cytology. Ferritin levels for the poorly-differentiated and advanced stage groups were higher than those for the well-differentiated and early stage groups, and were especially high in 5 of the 7 patients with renal pelvic and ureteral cancer and all of the 7 patients with bladder cancer involving the upper urinary tract. These data suggest that determination of urinary ferritin is useful in the detection of urinary tract cancer involving the upper urinary tract. The upper limits of CEA levels were determined respectively according to white blood cell counts in urine. Although, CEA levels were elevated in the poorly-differentiated group and the advanced stage group compared to the well-differentiated and early stage groups, the values were positive in only 12 out of 52 cases (23.1%). These values seemed to be low compared to other reports. beta 2-MG levels increased significantly in the poorly-differentiated and advanced stage groups. However, most cases in the above groups were complicated with pyelonephritis or renal impairment. It is suggested that the urinary beta 2-MG secretion from cancer itself is not so significant.(ABSTRACT TRUNCATED AT 250 WORDS)

New concepts in staging and follow-up of bladder carcinoma

This article presents new staging systems and methods for properly assessing bladder carcinoma by computerized tomography (CT) scanning and transurethral ultrasound. The practical clinical modalities for following bladder cancer including cytology and random biopsy are presented, in addition to tumor markers. Also, newer methods of detecting recurrence and predicting invasion such as ABO(H) antigen testing, chromosome analysis, and flow cytometry are reviewed in an attempt to understand better the cellular and nuclear abnormalities in malignant transitional cells.

Prediction of survival and recurrence in bladder carcinoma

We have followed a large population of patients receiving radiation treatment for bladder carcinoma with respect to survival and recurrence-free survival. Bivariate and multivariate life table analyses have been performed using a set of independent variables. The most important were T class, grade (G), urinary carcinoembryonic antigen (U-CEA) taken before treatment and cytological analysis 4 months after treatment. We compared the usual way of classifying a patient (T + G) with the combination of U-CEA and cytology since the latter two variables seemed to have great prognostic importance. The analyses show that T + G gives the best significance for survival (p = 0.0003) while U-CEA and cytology is better for recurrence-free survival (rho = 0.0002). 0.0002).

Urinary CEA for prediction of survival time and recurrence in bladder cancer

The prognostic information from carcinoembryonic antigen was evaluated in bacteria-free urines of patients with bladder carcinoma. Patients with elevated (greater than or equal to 30 ng/ml) U-CEA had a poorer relative and symptom-free survival than patients with initial U-CEA below 30 ng/ml. Patients in whom U-CEA decreased from before to after radiation treatment had a better survival rate than patients with increasing U-CEA. These findings were most significant in cases with large (T3 + T4) tumors or with tumors of a lower differentiation (G3). U-CEA appeared to be an independent variable for prognostic evaluation of survival, since these differences were also true within the subgroups of known variables such as classes or grades. All but one of the patients, in whom short-term local control was obtained, had a posttreatment U-CEA below 50 ng/ml. In oncology units, where the more malignant bladder tumors are treated, U-CEA determinations may indicate which patients require intensified monitoring or treatment.

[Current immunologic findings in bladder cancer]

As a result of the growing significance of immunological findings in malignant growths, more attention is being paid to these questions in the diagnosis and treatment of carcinomas of the urinary bladder in humans. In this particular field the findings are not very numerous. In the field of immunodiagnosis demonstrable immunoreactions caused by cells seem to possess greater significance. Skin tests have only had prognostic significance to date. In the field of immunotherapy a non-specific BCG treatment was carried out on a small number of patients with various forms of application. These results do not give any certain information. The author refers to studies on chemically induced carcinomas of the urinary bladder in animals.

Carcinoembryonic antigen localization in benign and malignant transitional epithelium

Transitional epithelium from 30 cases, including transitional cell carcinoma of various grades and stages, carcinoma in situ, cystitis cystica, and glandularis, as well as normal bladder epithelium, was studied for carcinoembryonic antigen (CEA) content by the immunoperoxidase technique. The results indicate that CEA is present in normal transitional epithelium and that its level frequently decreases in transitional cell carcinoma. These results are related to the findings in studies of urinary CEA excretion.

Assessment of serial CEA determinations in urine of patients with bladder carcinoma

Carcinoembryonic antigen (CEA) levels in urine and serum from 294 patients with bladder cancer in varying stages have been clinically evaluated. All urine samples were obtained from patients with intact renal function and without bacterial infection in the bladder. The samples were collected before, during, and at follow-up examination after radiotherapy. They were perchloric acid extracted before being assayed in a double-antibody radioimmunoassay. The geometric mean of urine CEA levels for patients with primary tumors of Stage T1 or T2 was significantly lower than that for those with Stage T3 or T4 disease. The urine CEA levels for patients with tumors of various histologic grades did not differ. The urine CEA levels decreased from before to after radiation treatment of the primary tumor. Patients with recurrence within six months after undergoing primary treatment had higher initial mean urine CEA levels than did those without evidence of recurrence. The prognostic information for recurrence was limited to the more advanced tumors. Differences were also found between the means of samples taken before recurrence and after treatment of recurrent tumors; with regression of the tumor, a lower mean urine CEA level was found; with progression, a higher value. Urine CEA levels before any treatment were higher when the patients had a short survival time. Serum CEA levels were not related to stage or grade of the primary bladder tumor but levels were slightly elevated with metastases. The determination of urine CEA levels seems to be useful in the follow-up of patients with bladder carcinoma because when initially high, it adds to the information of the T classification and predicts early recurrence, and the monitoring of individual patients after primary treatment is useful for detecting recurrence.

Screening tests for detection of bladder cancer

Eighty-one individuals had urine cytologic studies, urinary carcinoembryonic antigen (CEA) determinations, and urinary immunoglobulin levels performed to evaluate various screening tests for the diagnosis of bladder cancer. Urinary cytologic studies detect the presence of bladder malignancy, and while false positive tests were troublesome, remain the primary screening test for bladder cancer. Urinary CEA was of little value in detecting vesical malignancy. Urinary immunoglobulins, particularly IGG and IGA, were significantly elevated in the presence of bladder cancer.

Inverted papilloma of the urinary bladder: ultrastructural and immunologic studies

The histologic, ultrastructural, and immunologic features of an inverted urinary bladder papilloma were studied with thin-section and freeze-fracture electron microscopy, a specific red blood cell adherence test, and through analysis of urine carcinoembryonic antigen (CEA). The increased number of gap junctions and desmosomes, the presence of thickened and reduplicated basal laminae, and the normal CEA levels found in association with this neoplasm, correlate well with its generally predictable benign behavior.

Screening tests for the detection of bladder cancer

Eighty-one individuals had urine cytologies, urinary carcinoembryonic antigen (CEA) determinations and urinary immunoglobulin levels performed in an effort to evaluate various screening tests for the diagnosis of bladder cancer. Urinary cytologies had a predictive value of 57% in detecting bladder cancer. Urinary CEA was of little value in detecting vesical malignancy. Urinary immunoglobulins, particularly IgG and IgA were significantly elevated in the presence of bladder cancer.

Effects of therapy on carcinoembryonic antigen activity in the urines of patients with cancer of the bladder

Carcino-embryonic antigen (CEA) levels were quantitated in specimens of urine for 16 patients with invasive transitional-cell carcinoma of the urinary bladder. Four of the patients had received x-irradiation to the bladder and four had been treated with the radiomimetic agent, thiotepa. Urinary CEA levels in these patients (3.7 +/- 2.4 ng/ml) were significantly lower (t = 6.17, P less than .001) than levels from a similar group of eight patients who had not been treated with radiotherapy (20.3 +/- 8.7 ng/ml). These results suggest that "false-negative" urinary CEA levels may, in some cases, be associated with previous radiotherapy.

[Clinical significance of urinary CEA measurement as a screening test of bladder cancer (author's transl)]

Non-infected urine samples of twenty six preoperative bladder cancers were examined by urinary CEA radioimmunoassay and exfoliative cytology. There were 65% of urinary CEA positivity and 58% of cytological positivity (class III, IV, V). CEA measurements were positive in 8 of 11 negative cytology cases (class I and II). Exfoliative cytological examination failed to detect most of well differentiated transitional cell carcinomas, while urinary CEA study detected 4 of 6 such cases. Combination of both urinary CEA measurement and cytology resulted in 85% of positivity. Therefore we recommend routine use of this combination as a screening system of bladder cancer.

Improved performance of a double antibody radioimmunoassay for carcinoembryonic antigen

A new double antibody solid-phase radioimmunoassay (RIA) for carcinoembryonic antigen (CEA) is critically analyzed. The aim of the study was 4-fold: (a) to define the level of sensitivity (a comparison of 3 different assay procedures revealed that our sequential assay was more sensitive than most previously reported RIAs, while competitive and non-equilibrium assay had wider measuring ranges); (b) to analyze recoveries of CEA in either serum, plasma or urine (the recovery, even in urine, was very close to expected values, indicating that no CEA is lost or degraded during brief storage or in the extraction procedure); (c) to evaluate inter- and intra-assay variations, since most clinical management is dependent on serial assays rather than single determinations. The coefficients of variation were low both within and between assays. A change of 3 ng CEA is required for significant change (greater than 2 S.D.) at the normal serum level which is 16 ng CEA/ml in our assay. At levels above normal, a change of 4 ng is required; (d) the assay was also developed for determination of CEA levels in a large series of perchlorid acid treated serum, plasma or urine samples. This forms the basis for an assay suitable for serial assays with high sensitivity and accuracy in various neoplastic diseases.