Tumor Markers as Predictors of Acute Kidney Injury Incidence and Staging of the Muscle-Invasive Bladder Cancer Receiving Chemoradiation Therapy

Sep 24, 2026

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Background: Bladder cancer in the urinary tract is linked with higher acute kidney injury (AKI) risk, worsening prognosis, interrupting effective oncological therapy, prolonging hospitalization, and increasing costs. Tumor marker roles in bladder cancer staging remain insufficiently discussed despite recent molecular subtyping advances. This retrospective study examined whether tumor markers predict AKI incidence and relate to cancer staging. Methods: Secondary data from 26 bladder cancer medical records (2021–2022) were analyzed. Statistical tests compared continuous and categorical variables and assessed pre- and post-chemoradiation marker changes.

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CategoryHealthcare

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Original Article World J Oncol. 2023;14(5):423-429 Tumor Markers as Predictors of Acute Kidney Injury Incidence and Staging of the Muscle-Invasive Bladder Cancer Receiving Chemoradiation Therapy Syah Mirsya Warlia, b, e, Fauriski Febrian Prapiskab, Dewi Indah Sari Siregarc, Ilham Ari Sejad Abstract Background: Bladder cancer, as one of types of cancers within the urinary tract, is associated with a greater risk of acute kidney injury (AKI), resulting in a poorer prognosis, discontinuation of effective oncological treatments, longer hospitalization, and higher expenses. There is no discussion yet on tumor markers in bladder cancer. With the revolutionary advances in bladder cancer molecular subtyping over the past decade, the presence of tumor markers to assess the staging of bladder cancer has yet to be discussed. In this study, we intended to assess the relationship between tumor markers and incidence ofAKI, also between tumor markers and the cancer staging. Methods: This retrospective cross-sectional study utilized secondary data from 26 medical records of patients diagnosed with bladder cancer at the Adam Malik and Universitas Sumatera Utara Hospital between 2021and 2022. This study included all patients with bladder cancer who met the inclusion criteria. Continuous variables were reported as mean (standard deviation (SD)) and examined using an independent t-test. Categorical variables were reported as proportions, examined using Chi-square or Fisher’s exact test. Pre-and post-tumor marker data were evaluated with dependent sample t-test for normal variance data, and Wilcoxon test for data with atypical distribution. P values were set at 0.05. Results: CD44 (P = 0.003) and programmed cell death 1 (PD-1) (P = 0.030) were the only significant markers in their pre- and postchemoradiation states among the four investigated tumor markers in Manuscript submitted August 1, 2023, accepted August 23, 2023 Published online September 20, 2023 aDivision of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan, Indonesia bDepartment of Urology, Faculty of Medicine, Universitas Sumatera Utara Hospital-Universitas Sumatera Utara, Medan, Indonesia cDepartment of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara Hospital-Universitas Sumatera Utara, Medan, Indonesia dDepartment of Urology, Faculty of Medicine, Universitas Indonesia - Haji Adam Malik General Hospital, Medan, Indonesia eCorresponding Author: Syah Mirsya Warli, Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan, [Indonesia. Email: warli@usu.ac.id](Indonesia. Email: warli@usu.ac.id) doi: [https://doi.org/10.14740/wjon1676](https://doi.org/10.14740/wjon1676) this study. Meanwhile, PD-1 tumor marker levels were only found to be significant between AKI and pre-chemoradiation (P = 0.011) . Even though the multivariate study of tumor staging did not show any statistical significance, both tumor markers CD44 and PD-1 showed a significant effect on the incidence of acute renal damage (P = 0.034) . Conclusions: Pre-chemoradiation PD-1 tumor markers showed promise as good predictive indicators for staging and AKI incidence in muscle-invasive bladder cancer patients undergoing chemoradiation therapy. Keywords: Muscle-invasive bladder cancer; Acute kidney injury; Tumor marker; Staging; Chemoradiation; Tumor marker Introduction Bladder cancer is one of many malignancies of the urinary tract. In 2020, there is an estimation of 80,000 novel cases and 17,980 deaths [1] . The majority of patients (70%) had nonmuscle-invasive bladder cancer (NMIBC) with high recurrence risk (50-70%) and can further advance to muscle-invasive bladder cancer (MIBC) in approximately 10-20% of patients. Bladder cancers are staged according to the eighth edition of the tumor, node, metastasis (T, N, and M) by the Americ

FAQs

What was the main purpose of the study?

To evaluate the relationship between tumor markers and acute kidney injury incidence, and between tumor markers and cancer staging in muscle-invasive bladder cancer patients receiving chemoradiation therapy.

How was the study designed and what data were used?

It used a retrospective cross-sectional design with secondary data from 26 medical records collected between 2021 and 2022.

Which tumor markers showed significant predictive associations?

CD44 and programmed cell death 1 (PD-1) were the only significant markers across pre- and post-chemoradiation states, and PD-1 also showed significance between AKI and pre-chemoradiation.

Sep 24, 2026

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