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

Objective To evaluate angiogenesis as a prognostic marker of transitio nal cell carcinoma of the bladder and to assess its relationship to es tablished variables for survival. Materials and methods Forty-five tum ours (two G(2)T(2), seven G(3)T(2) and 36 G(3)T(3)) from 36 men and ni ne women with a mean age of 73 years (range 50-91), who had been follo wed-up for a median of 37 months (range 1-50), were examined. Vessels were immunohistochemically highlighted using an antibody to the platel et endothelial cell adhesion molecule, CD31. Microvessel density was q uantified using a Chalkley point eyepiece graticule. Results Univariat e analysis of survival showed stage, grade and vascular count were sig nificant indicators of prognosis (P=0.002, P=0.007, P=0.019 respective ly). 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 indic ator (P=0.026) but was as informative as stage in predicting overall s urvival. A high vascular count conferred a 2.5 increased risk of morta lity. Conclusions These findings suggest that assessment of angiogenes is by microvessel quantification is an independent predictor of surviv al in patients with invasive bladder carcinoma and might be useful in selecting those who would benefit from adjuvant therapy.