High CA19-9 levels can increase risk of recurrence and death in upper urothelial carcinoma patients

A research team at Seoul National University Hospital has discovered that the CA19-9 level, used as a diagnostic index for pancreatic cancer, is closely related to upper urothelial cancer, cancer occurring in the kidney.

Urinary tract epithelial cancer develops in the epithelial cells of the urinary tract through which urine flows. If cancer develops in the upper part of the urinary tract, it is called upper urothelial cancer. Although rare compared to bladder cancer, it is a carcinoma with a steadily increasing incidence.

For upper urothelial cancer, the treatment guidelines differ depending on the progress of cancer, such as a wider resection area in the high-risk group.

Hospitals judge progression through computed tomography (CT) scans, which have limitations as it is not entirely accurate. To set up an appropriate treatment policy, it is necessary to have an index reflecting the size of the cancer and the degree of metastasis to complement existing methods.

The SNUH team, led by Professors Ku Ja-hyeon, Yuk Hyeong-dong, and Jeong Seung-hwan of the Department of Urology, focused on CA19-9 levels, often used to predict the prognosis of pancreatic cancer and digestive system cancer.

The researchers divided 227 patients who underwent surgery for upper urothelial cancer at the hospital, checked their CA19-9 levels before surgery into two groups -- the low group (≤37 U/ml, 199 patients) and the high group (>37 U/ml, 28 patients) – and compared the cancer progression.

The result showed that the group with high CA19-9 levels had larger and more aggressive tumors before and after surgery than those with low CA19-9 levels. In addition, the group with higher CA19-9 levels showed more cancer spread to surrounding lymph nodes after surgery.

Also, the research team corrected the cancer progression status of the two groups to a similar level through propensity score matching and analyzed the correlation between CA19-9 levels and surgical prognosis.

As a result, the two-year metastasis-free survival rates and the overall survival rates of the group with high and low CA19-9 levels were 22.5 and 71.2 percent and 79.8 and 95.4 percent, respectively.

“The CA19-9 level can reflect the progression and malignancy of upper urothelial cancer, as in other cancers such as pancreatic cancer,” Professor Jeong said. “It is expected that the CA19-9 level can be used as a prognostic predictor when treating upper urothelial cancer patients in the future.”

The research results were published in the latest issue of Frontiers in Oncology.