QUANTIFICATION OF ANGIOGENESIS AS AN INDEPENDENT PREDICTOR OF PROGNOSIS IN INVASIVE BLADDER CARCINOMAS

Objective To evaluate angiogenesis as a prognostic marker of transitional cell carcinoma of the bladder and to assess its relationship to established variables for survival. Materials and methods Forty-five tumours (two G(2)T(2), seven G(3)T(2) and 36 G(3)T(3)) from 36 men and nine women with a mean age of 73 years (range 50-91), who had been followed-up for a median of 37 months (range 1-50), were examined. Vessels were immunohistochemically highlighted using an antibody to the platelet endothelial cell adhesion molecule, CD31. Microvessel density was quantified using a Chalkley point eyepiece graticule. Results Univariate analysis of survival showed stage, grade and vascular count were significant indicators of prognosis (P=0.002, P=0.007, P=0.019 respectively). No relationship was observed between stage and grade and vascular count. In a Cox proportional hazard model, adjusted for age and stage, microvessel density not only remained a significant prognostic indicator (P=0.026) but was as informative as stage in predicting overall survival. A high vascular count conferred a 2.5 increased risk of mortality. Conclusions These findings suggest that assessment of angiogenesis by microvessel quantification is an independent predictor of survival in patients with invasive bladder carcinoma and might be useful in selecting those who would benefit from adjuvant therapy.