Prognostic significance of angiogenesis in transitional cell carcinoma of the human urinary bladder

OBJECTIVES: To quantify tumour angiogenesis in bladder cancer and determine whether it correlates with tumour stage, grade and survival. PATIENTS AND METHODS: Archival samples from a total of 113 patients newly presenting with transitional cell carcinomas of the urinary bladder were graded and staged, and analysed for angiogenic blood vessel density by a double immunohistochemical technique. The findings were correlated with the information obtained during a minimum follow-up of 12 years. RESULTS: Univariate analysis showed that TNM stage (P = 0.02) and mean vessel count (P = 0.01) were significant predictors of death from bladder cancer. Blood vessel density was significantly correlated with tumour stage (P = 0.01) and the presence of vascular invasion (P = 0.007). Trained observers were essential for the accurate counting of blood vessels to prevent excessive inter-observer variability. Multiple regression analysis showed that the combination of mean vessel count and stage was a significant prognostic indicator. CONCLUSION: Angiogenesis in primary bladder cancer is a predictor of death from the disease. Further work to determine whether it predicts invasion and recurrences in superficial tumours may be valuable.