CEA Expression in Muscle-Invasive Bladder Cancer Unrelated to Disease Course

What is it about?

This study analyzes the expression of carcinoembryonic antigen (CEA) in urothelial bladder neoplasms using immunohistochemistry in a tissue microarray format. The study finds that CEA expression occurs in a significant fraction of pT2-4 urothelial bladder carcinomas, with higher rates in non-invasive urothelial bladder carcinomas. The study also finds that CEA expression in pT2-4 carcinomas is not associated with clinicopathological factors, and its prognostic impact is unclear. The study suggests that CEA positivity in pT2-4 carcinomas provides an opportunity for using CEA serum measurement for monitoring the clinical course of these cancers and that CEA positive urothelial carcinomas are candidates for treatment with targeted anti-CEA drugs.

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Why is it important?

The research is important as it evaluates the potential clinical significance of CEA expression in urothelial bladder neoplasms. The study analyses CEA by immunohistochemistry in more than 2500 urothelial bladder carcinomas in a tissue microarray format. The high intra-laboratory consistency of data is enabled by a consistent staining interpretation and a highly validated staining approach. The assay for CEA analysis has previously been validated according to the guidelines of the international working group for antibody validation (IWGAV) by comparison with a second independent antibody. The research findings have important implications for the use of CEA serum measurement for monitoring the clinical course of urothelial bladder cancers and for patients who are candidates for surgical resection or systemic therapy. Key Takeaways: 1. CEA staining was largely absent in normal urothelial cells but was observed in 30.4% of urothelial bladder carcinomas including 406 (16.7%) with weak, 140 (5.8%) with moderate, and 192 (7.9%) with strong staining. 2. CEA positivity occurred in 10.9% of 411 pTaG2 low-grade, 32.0% of 178 pTaG2 high-grade, and 43.0% of 93 pTaG3 tumours. 3. In 1335 pT2-4 carcinomas, CEA positivity (34.1%) was lower than in pTaG3 tumours. 4. Within pT2-4 carcinomas, CEA staining was unrelated to pT, pN, grade, L-status, V-status, overall survival, recurrence-free survival, and cancer-specific survival (p > 0.25). 5. The high rate of CEA positivity in pT2-4 carcinomas offers the opportunity of using CEA serum measurement for monitoring the clinical course of these cancers. 6. CEA positive urothelial carcinomas are candidates for a treatment by targeted anti-CEA drugs.