Clinical analyses of Japanese bladder and upper urinary tract (UUT) cancers using the level of serum amylase (Amy): theirs prognosis and treatment

Bladder and upper urinary tract (UUT; pelvic and/or ureteral) cancers were studied in a total of 118 Japanese patients using serum amylase to clarify their prognosis and treatment. Among 114 patients with urothelial carcinoma (UC), 99, 10, and five had bladder UC, bladder-UUT-UC, and UUT-UC alone, respectively. Three had bladder squamous cell carcinoma, and one had undifferentiated bladder carcinoma. During the 3 years of this study (2007–2009), 35 (30%) patients received radical cystectomy at a mean age of 72 ± 8 years old, of which 23 (66%) demonstrated muscle invasion (pT2≤). Five (4%) patients showed post-operative hyperamylasemia with serum amylase levels of 1,353–2,986 IU/l. Except for one case of UUT-UC with mild operative bleeding, in four other bladder UC cases, severe fibrinolytic bleeding was observed, and their continuing bleeding was accompanied by a post-operative elevated serum amylase. One patient with a serum amylase level of 2,986 IU/l showed severe post-operative pelvic bleeding and severely necrotic UC recurrence involving prostate and urethral remnants and died of intestinal perforation about 1 year post-cystectomy. Serum amylase was secreted from bladder cancers in parallel with the amount of tissue-type plasminogen activator (t-PA), although serum amylase secreted maximally a little later than t-PA after serum Ca was returning to normal. Five patients showed brain metastases with a low level of serum amylase, near to normal serum Ca, and high levels of alkaline phosphatase at advanced cancer stages, and another four with hypercoagulation showed cerebral infarction with similar laboratory findings to those of the former five, of which three had severe chronic renal failure. The proteolytic reactions of the urokinase-type PA secreted from bladder cancer caused tissue necrosis, especially in the intestine, resulting in intestinal perforation and remote bone and brain metastases. In the CRF patients, recombinant erythropoietin was effective for treating hypoxia.