Tumor markers already play an important part in the management of the urologic neoplasm. As the number of emerging markers increases, clinical judgement may be an even more important part of the use of tumor markers. Ideally, a tumor marker should be produced reliably only by a specific malignancy, be easily and reproducibly measured, be detectable when a tumor is in its early stages and correlate with a response to therapy. Unfortunately, an ideal tumor marker has not yet been identified.
Tissue polypeptide antigen(TPA) is heterogeneous in nature and SDS-polyarcrylamide gel electrophorsis resolves it into components with molecular weights raging from 45,000 to less than 20,000. Thus TPA is capable of being filtered through the kidney and excreted in the urine. The increased levels of TPA in urine and serum are probably due to a more rapid turnover and autolysis of cells and may parallel a more aggressive tumor behavior.
Carcinoembryonic antigen(CEA) is a glycoprotein first found in extracts of human colonic cancer and the colon of human fetus during the first trimester of pregnancy. Initially it was considered that plasma CEA elevations were found only in case of endodermally-derived carcinomas. As bladder is, in part, endodermally-derived, this led Hall et al. to look for raised plasma and urine CEA levels in patients with urothelial carcinoma.
We measured the TPA and CEA levels of 24-hours urine from 20 healthy individuals and 96 patients with definitive transitional cell carcinoma of the urinary bladder. And we evaluated the corelationships with grades, stages and recurrence of transitional cell carcinoma of the urinary bladder.
The results are as follows；
1. Positive values(mean+2S.D.) of TPA and CEA levels of 24-hours urine showed significant differences between normal individuals and patients with transitional cell carcinoma of the urinary bladder(p<0.001 and p<0.05, respectively).
2. TPA and CEA levels in 24-hours urine showed significant differences between normal individuals and patients with transitional cell carcinoma of the urinary bladder(p<0.001 and p<0.05, respectively).
3. TPA levels in 24-hours urine of patients with transitional cell carclinoma of the urinary bladder showed significant difference in each grades or each stages.
4. CEA levels in 24-hours urine of patients with transitional cell carnoma of the urinary bladder did not show significant difference in each grades or each stages.
5. The recurrence rate in stage A patients whose 24-hours urine TPA level were above the positive value was 77％. The recurrence rate in stage A patients whose 24-hours urine CEA level were above the positive value was 66.7％
So, TPA level of 24-hours urine in patients with transitional cell carcinoma of the urinary bladder can be a good tumor marker and show the more close corelationships with tumor grades or stages than CEA levels of 24-hours urine in patients with transitional cell carcinoma of the urinary bladder.
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