The prognostic value of angiogenesis factor expression for predicting recurrence and metastasis of bladder cancer after neoadjuvant chemotherapy and radical cystectomy

To determine the prognostic value of angiogenesis factor expression for pat ients with muscle-invasive transitional cell carcinoma (TCC) of the bladder treated with neoadjuvant methotrexate, vinblastine, doxorubicin, and cispl atin (M-VAC) chemotherapy and radical cystectomy, we evaluated the expressi on of basic fibroblast growth factor (bFGF), vascular endothelial growth fa ctor (VEGF), and interleukin 8 (IL-8) by in situ hybridization, and we dete rmined microvessel density (MVD) by immunohistochemistry. These factors wer e evaluated in 55 biopsy specimens prior to therapy and in the cystectomy s pecimens of 51 patients after completion of therapy, By univariate analysis , VEGF expression and MVD in the biopsy specimens were significant predicto rs of disease recurrence. By multivariate analysis, only VEGF expression wa s an independent prognostic factor. Pathological stage, bFGF expression, an d MVD in the cystectomy specimens after therapy were all independent progno stic factors for disease recurrence. The results of this exploratory study indicate that the expression levels of VEGF and bFGF as indicated by in sit u hybridization and MVD as indicated by immunohistochemistry identify patie nts with muscle-invasive TCC who are at high risk of developing metastasis after aggressive therapy with systemic M-VAC chemotherapy and radical cyste ctomy.