Morphometric microvascular characteristics predict prognosis in superficial and invasive bladder cancer

Recent research has shown that neovascularization, quantitated by microvess el density (MVD), constitutes a strong prognostic indicator in patients wit h invasive urothelial carcinomas. These studies, however, have focused only on MVD as the only factor reflecting angiogenesis in transitional-cell car cinomas (TCCs). The objective of this report was to evaluate multiple morph ometric microvascular characteristics besides MVD in superficial and muscle -invasive TCCs separately, to provide a better approach to the relationship between angiogenesis, clinicopathological parameters, and prognosis. Histo logic sections from 115 TCCs [35 superficial (TI) and 80 muscle-invasive] w ere immunostained for CD31 and evaluated using image analysis for the quant itation of MVD, area, total vascular area, major axis length, minor axis le ngth, perimeter, compactness, shape factor, and Feret diameter. Patients we re followed-up until death (n = 31) or for an average of 42.2 months (media n 38.5 months). MVD increased with progressing T category (P = 0.049) but a rea (P = 0.033), major axis length (P = 0.022), perimeter (P = 0.043), and Feret diameter (P = 0.042) were highest in T2 tumors. Area was the single i ndependent predictor of adverse significance in T I TCCs, whereas for muscl e-invasive tumors, survival was independently predicted by MVD. Regarding d isease-free survival in superficial tumors, the single significant independ ent parameter was compactness, whereas area was an independent favorable in dicator of disease-free survival for patients with invasive TCCs. It is con cluded that the prognostic significance of neovascularization is better ass essed by area and shape-related morphometric characteristics, whereas MVD b ecomes influential only with regard to overall survival of patients with in vasive tumors.