Prognostic value of angiogenesis and vascular invasion in muscle-invasive bladder cancer.

Angiogenesis is important in the pathogenesis of tumors and correlates with clinical outcome in certain malignancies. Recent advances in staining techniques have raised doubts about the prognostic value of vascular invasion in muscle-invasive bladder cancer, for which relatively few predictors for survival exist. Twenty-one radical cystectomy specimens from patients with stage pT2-3NOMO transitional cell tumors were examined by staining with Hematoxylin and Eosin (H&E). Factor VIII-related antigen (FVIII RAG) which is specific for vascular endothelium, and MOVAT which highlights large vessels. Angiogenesis, estimated by microvessel density, and presence of vascular invasion were then correlated with survival in the follow-up period which ranged from 3 to 141 months. Six of 21 patients survived disease-free with follow-up ranging from 47 to 141 months. Twelve patients had lower microvessel density than 178/mm2 and five of these survived, whereas only one of nine patients having higher microvessel density survived. Twelve of 21 patients had vascular invasion and three survived whereas three of nine patients without vascular invasion survived. There was no correlation found between vascular invasion and survival in this study. Analysis by Kaplan-Meir survival curves demonstrated trends which were not statistically significant between high and low angiogenesis groups. The preliminary data suggest that further assessment of the prognostic role of angiogenesis and vascular invasion in muscle-invasive bladder cancer is indicated.