Serum cholinesterase: a cost-effective prognostic predictor in urothelial carcinoma of the bladder

Abstract Background: Serum cholinesterase (CHE) has been reported to affect the prognosis of several cancers. In this study, we examined the relationship between serum CHE levels and clinical aspects of urothelial carcinoma of the bladder (UCB). Methods: We retrospectively analyzed clinical data collected from 279 patients diagnosed with UCB at our hospital from 2010 to 2016. Using regression, we examined the relationship of serum CHElevels at different pre- and postoperative time points with prognosis. Follow-up was conducted from the date of surgery to December 31, 2019. Results: Preoperative serum CHE was associated with tumor size, pathological grade, squamous differentiation, invasion, muscle-invasion, lymph node metastasis, distant metastasis, and recurrence of UCB. Logistic regression identified low preoperative serum CHE levels as an independent risk factor of higher pathological grade and invasion. Postoperative serum CHE levels decreased significantly faster among UCB patients who had undergone radical cystectomy than those who had undergone non-radical cystectomy, then increase to the original basic level, suggesting feedback mechanisms in patients with UCB that restored baseline CHE levels. Low levels of preoperative serum CHE were associated with poor progression-free survival and overall survival. Cox regression showed that low levels of preoperative serum CHE are an independent predictive factor for poor prognosis in patients with muscle-invasive urothelial carcinoma of the bladder without distant metastasis. Receiver operating characteristic curves showed that low preoperative serum CHE levels can be a moderately reliable predictor of recurrence and death among patients with muscle-invasive UCB. Conclusion: Preoperative serum CHE levels in patients with UCB negatively correlate with pathological grade and invasion. Low preoperative serum CHE levels can predict poor prognosis in patients with muscle-invasive UCB without metastasis. Further research much be conducted to gain a better understanding of the mechanisms through which serum CHE levels affect UCB progression.