The abnormal changes in CSTMs were severer in UTUC patients and it could be dropped off after surgical treatment
We analyzed all abnormal changes of CSTM in UTUC, simple hydronephrosis with no carcinoma and renal cell carcinoma patients. The positive rate of abnormal changes in CSTM was higher in UTUC patients than that in other two groups (Table 1). We especially take a comparison between ureteral TCC and simple hydronephrosis with no carcinoma patients as they shared same characteristic on hydronephrosis. We found that although hydrops of renal pelvis in simple hydronephrosis patient was more serious than that in ureteral TCC patient, the positive rate of abnormal CSTM changes in ureteral TCC showed significantly higher than that in simple hydronephrosis (Table 2). These results indicated that UTUC was a leading cause of abnormal CSTM changes but not the hydronephrosis or other renal tumor.
Totally 19 UTUC patients had underwent surgical treatment in our hospital. CSTMs changes in these patients before and after surgery were compared (Table 3). We found the number of abnormal CSTM changes was decreased after surgery (P = 0.02). The rate of abnormal CSTM changes was decreased but with no statistical significance, which may due to that just one indicator was abnormal would seemed as positive even if actual value had dropped.
UTUC pathological progression may effect abnormal CSTM changes
Tumor metastasis were confirmed by CT scanning, including invasion of adjacent tissues and lymph node metastasis. UTUC patients were divided into four group according to metastasis status and tumor site: non-metastasis ureteral TCC, non-metastasis renal pelvic TCC, metastasis ureteral TCC, metastasis renal pelvic TCC. As presented in the Table 4, rate of abnormal changes in the CSTMs was found in metastatic UTUC patients (6 in 6, 100%) and non-metastatic UTUC patients (18 in 34, 51.43%) with statistically difference between two groups (one side P = 0.04). These results suggested that UTUC metastasis may exist correlation with abnormal CSTM changes.
As all metastasis UTUC patients presented abnormal CSTM changes, we analyzed the effect of tumor grade and tumor infiltration on CSTM changes in non-metastasis UTUC patients. According to the result of tissue biopsy, patients were divided into four groups: low grade UTUC, high grade UTUC, non-infiltrative UTUC, infiltrative UTUC. As presented in the Table 5, for non-metastatic UTUC patients, the rate of abnormal changes in CSTMs in low grade UTUC was significantly increased than that in high grade UTUC (P = 0.02), as well as higher in non-infiltrative UTUC than that in infiltrative UTUC (P = 0.02). These results suggested that low tumor grade may promote abnormal CSTM changes, and non-infiltrative tumor may had stronger effect on rising CSTM levels.
The association between tumor load and CSTM levels (Table 6) in UTUC patients was assessed. The liner regression analysis result showed no statistical significance between the tumor load and the number of abnormal CSTM changes in non-metastatic UTUC cases (P = 0.35).
Hydronephrosis may be one factor on abnormal CSTM changes
We tried to find the association between hydronephrosis status and abnormal CSTM changes in non-metastasis UTUC patients (Table 7). A positive correlation existed between the severity of hydronephrosis and the number of abnormal CSTM changes in non-metastatic ureteral TCC (P = 0.01) and in non-metastatic renal pelvic TCC (P = 0.03). Hydrop length (HL) was measured for hydronephrosis assessing by CT scan which were described in methods. The liner regression analysis on the status of hydronephrosis and the number of abnormal CSTM changes in non-metastatic ureteral TCC and renal pelvic TCC even given formulas: Number of abnormal CSTM changes = - 0.2369+ 0.0456 × HL (P = 0.01) and -0.0837 + 0.0364 × HL (P = 0.03). The linear regression equation between the status of hydronephrosis and the abnormal CSTM in non-metastatic UTUC was: Number of abnormal changes in CSTM = -0.1869+0.0437× HL (P < 0.0001).These results indicated that hydronephrosis status induced by UTUC may have effect on rising CSTM levels.
It seemed that hydronephrosis status and tumor metastasis both played a role on abnormal CSTM changes, a comparison was carried out between both of them. The status of hydronephrosis showed difference between metastatic UTUC patients (32.91 ± 20.06 mm) and non-metastatic UTUC patients (23.22 ± 14.58 mm), but without statistical significance (Table 8, P = 0.35). This suggested that hydronephrosis status and tumor metastasis were both independent contributing factors.
Serum level of CA199, CA242, CA724 and CEA may be helpful for UTUC prognosis
We showed all 7 CSTM testing results and status of hydronephrosis in Table 9. There is no abnormal result of CA125 or AFP in UTUC patients, so no comparison was did in this table. A linear regression analysis was used between the status of hydronephrosis and each CSTM level. There were obvious positive correlation between the status of hydronephrosis and the serum level of CA199 (P = 0.001) and CA242 (P = 0.006) in non-metastasis ureteral TCC patients. An obvious positive correlation was existed between the status of hydronephrosis and the serum level of CA724 (P = 0.0006) and CEA (P = 0.006) in non-metastasis renal pelvic TCC patients. However, in all, the linear regression analysis showed that the status of hydronephrosis was positively corrected with the serum level of CA199 (P<0.0001), CA242 (P = 0.0001) and CA724 (P = 0.04). According to these results, it seemed that serum level of CA199, CA242, CA724 and CEA may be helpful for UTUC prognosis.
CA199, CA724 and CEA were expressed in almost all UTUC tissues
The expressions of CA199, CA724 and CEA in UTUC tissues were as anti-CA242 antibody was failed to obtained. 4 different UTUC tissues of patients were picked randomly from participates included in this study. As showed in figure 2, Almost all UTUC tissues were expressing CA199, CA724 and CEA more or less. This may verified the abnormal levels of CSTMs may be originated from UTUC tissues.