Detection of a group of classic serum tumor markers (CSTMs) aids in the differential diagnosis and disease assessment of upper tract urothelial carcinoma (UTUC).

Background: Simple indicators are needed for the differential diagnosis and the monitoring of disease progression in upper tract urothelial carcinoma. This study aimed to explore the potential relationship between changes in classic serum tumor markers (CSTMs), including cancer antigen (CA) 242, CA199, CA125, carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), squamous cell carcinoma antigen (SCC), and CA724, and the differential diagnosis and disease assessment of UTUC. Methods: A total of 140 patients, of whom 60 had UTUC, 44 had clear cell renal cell carcinoma (ccRCC), and 36 had non-tumoral hydronephrosis (NTHN), were included in this retrospective, descriptive study. The initial CSTMs were compared among the three groups. The CSTMs were further analyzed at preoperative, short-term postoperative, and long-term postoperative or progressive disease (PD) time points in the UTUC group. A UTUC-CSTM test strategy was developed and validated in these comparisons. The pathological characteristics of the tumor and adjacent paracancerous tissues were analyzed. Results: CA242, CA199, and CEA were significantly higher in the UTUC group than in the ccRCC, NTHN or ccRCC + NTHN groups. The abnormal rates (ARs) of CA199, CEA, SCC, and CA724 were significantly higher in the UTUC group than in the ccRCC, NTHN, or ccRCC + NTHN groups. In the UTUC patients, the preoperative values of CA242 and CA199 were higher than the short-term postoperative values. In the UTUC patients, the long-term postoperative/PD values of CA242 and AFP were significantly higher than the short-term postoperative values. In the postoperative PD patients, the CA242, CA199, and AFP values were higher during PD than in the short-term postoperative period. In the UTUC patients, the preoperative AR values of CA199 and CEA were significantly higher than the short-term postoperative values. Based on these results, a test strategy combining CA242, CA199, CEA, AFP, SCC, and CA724 was developed and validated across all comparisons. The P values were consistently low, and the positive results covered all the comparisons. In 56 patients with surgical specimens, the number of CSTM changes detected using the recommended test strategy was statistically correlated with tumor load (P<0.001). In the UTUC tissues, antibody (Ab) labelling for CA199, CEA, AFP, CA724, and CA125 was positive, while in the paracancerous tissues, the Ab labelling was negative. Conclusions: CSTMs may aid in the differential diagnosis and disease assessment of UTUC. Group CSTM testing was shown to be more valuable than single CSTM testing. The recommended test strategy includes CA242, CA199, CEA, AFP, SCC, and CA724.