Microvessel density as a prognostic marker in bladder carcinoma: correlation with tumor grade, stage and prognosis.

INTRODUCTION: The aim of our study was to evaluate tumor angiogenesis as a prognostic marker of transitional cell carcinoma of the bladder and to asses its relationship to established variables for survival and response to therapy. PATIENTS AND METHOD: Microvessel density (MVD), a measure of tumor angiogenesis, were evaluated in 77 primary bladder cancers. Forty-three superficial carcinomas and 34 invasive carcinomas were analysed. Tumor specimens of all patients were obtained by transurethral resection (TUR) and all the tumors were transitional cell carcinomas. Twenty-two patients with invasive bladder cancer have undergone M-VEC chemotheraphy. The correlation between MVD and histopathological grade, tumor stage and prognosis was evaluated. MVD was identified by immunostaining of endothelial cells using anti-CD34 antibody. For statistical analysis Kruskal-Vallis, Mann-Whitney U and Fisher's exact tests were used. RESULTS: MVD was correlated with tumor grade, stage and prognosis. Significantly higher MVD was determined in invasive tumors than superficial tumors (p < 0.05). MVD increased with tumor grade and stage (p < 0.05). High MVD was correlated with the risk of clinical progression in both superficial and invasive bladder carcinomas (p < 0.05, p < 0.001 respectively). Invasive tumors with remission after M-VEC chemotheraphy had lower MVD than tumors with progression after M-VEC. CONCLUSION: These data demonstrate that MVD in bladder carcinoma correlates with grade, stage and malignant potential of the tumor. Quantification of tumor angiogenesis may allow selection of the type of treatment for bladder cancer patients.