Prognostic significance of angiogenesis in transitional cell carcinoma of the human urinary bladder

Objectives To quantify tumour angiogenesis in bladder cancer and determine whether it correlates with tumour stage, grade and survival. Patients and methods Archival samples from a total of 113 patients newly presenting with transitional cell carcinomas of the urinary bladder were graded and staged, and analysed for angiogenic blood vessel density by a double immunohistochemical technique, The findings were correlated with the information obtained during a minimum follow-up of 12 years. Results Univariate analysis showed that TNM stage (P = 0.02) and mean vessel count (P = 0.01) were significant predictors of death from bladder cancer. Blood vessel density was significantly correlated with tumour stage (P = 0.01) and the presence of vascular invasion (P = 0.007). Trained observers were essential for the accurate counting of blood vessels to prevent excessive inter-observer variability, Multiple regression analysis showed that the combination of mean vessel count and stage was a significant prognostic indicator. Conclusion Angiogenesis in primary bladder cancer is a predictor of death from the disease. Further work to determine whether it predicts invasion and recurrences in superficial tumours may be valuable.