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    EVALUATION OF SERUM LEVELS OF IMMUNOGLOBULINS (IgA, IgE, IgG, IgM), COMPLEMENTS (C3, C4) AND C-REACTIVE PROTEIN IN BLADDER CANCER: A CONTROLLED PROSPECTIVE CLINICAL TRIAL
    (Aves, 2005) Kilic, Suleyman; Bayraktar, Mehmet; Bayraktar, Nihayet; Ergin, Huseyin; Beytur, Ali; Egri, Mucahit
    Introduction: During the management of a patient with bladder cancer, the aim of a clinician is to diagnose the tumor with a most sensitive and least invasive method. Cystoscopy and urine cytology are standard practice in following these patients; however, cystoscopy is invasive, and urine cytology has low sensitivity. Therefore, this study aims to evaluate the diagnostic and prognostic value of the humoral immunity in the bladder cancer patients by means of measuring serum levels of immunoglobulins, complements and Creactive protein pre and postoperatively compared with controls. Materials and Methods: Blood and urine samples were taken from both tumor and control patients preoperatively and from only tumor patients at postoperative 1 and 3 months. Urine samples were examined immediately for microscopic examination and culturing. Serum samples were stored at -80 degrees C in a deep freeze till processing and assessed blindly by same person at the end of the study. Patients who preoperatively received intravesical BCG instillation therapy, radiotherapy or chemotherapy for their bladder carcinoma diseases were not included in tumor group. Patients who underwent a transurethral procedure for a nonneoplastic genitourinary disease and did not have any documented cancer, served as controls. Results: Mean ages of tumor (20 pts; 1 female, 19 males) and control (41 pts; 3 females, 38 males) patients were 64.2+/-9.9 and 63.7+/-8.9, respectively (p=0.846). All tumor patients completed 3 months of follow-up. There was no statistical difference in urinary infection incidences between tumor and control groups. Serum IgA, IgE, IgG, C3 and CRP levels were statistically significantly higher in tumor group than in control group, while lower C4 and indifferent IgM levels were present in tumor group compared to control. However following tumor resection, all of them decreased very significantly. All serum levels, except C4, of 6 patients with visible tumor in their bladders at postoperative 3rd month were similar to those of tumor-negative patients. Although preoperative high levels of IgA, IgE, IgG, C3 and CRP appeared as sensitive, specific and predictive in primary bladder tumor diagnosis, post-treatment levels of any of those above were not found as useful in follow-up, suggesting that these were not diagnostic and prognostic parameters for bladder tumor. No correlation was established between infection and serum levels in both groups since there were not statistically significant differences in serum immunoglobulins, complements and CRP levels between the patients with and without urinary infection in each group. Pathologic stage and grade of the tumor did not correlate with immunoglobulin and C4 levels. However, there was a significant positive correlation between stage and C3 or CRP. There were no differences between the 3rd month serum levels of patients who took no therapy (6 pts) or chemotherapy (5 pts) or intravesical BCG (9 pts) after resections, except C4 which was higher in patients who took chemotherapy than in those who took BCG. Conclusion: Although serum immunoglobulins, complements and CRP appear to be nondiagnostic for primary bladder carcinoma, wider studies with longer follow-up and higher patient population are necessary for more definitive conclusions.