Prognostic value of angiogenesis in schistosoma-associated squamous cell carcinoma of the urinary bladder.

Objectives: To evaluate angiogenesis as a prognostic marker in squamous cell carcinoma of the urinary bladder in 154 patients who underwent radical cystectomy.

Methods: The tumors from 98 men and 56 women (mean age 46.3 +/- 8.4 years) were examined. Vessels were stained using an antibody to the platelet endothelial cell adhesion molecule CD31. Microvessels were counted in active areas of angiogenesis within the tumors. Microvessel density (MVD) was quantified using the mean of three counts. Age, sex, tumor grade and stage, DNA ploidy, and MVD were evaluated in relation to outcome. Univariate and multivariate analyses of survival were performed.

Results: The median follow-up period was 63 months. The overall 5-year survival rate was 56 +/- 4.1. Tumor grade, tumor stage, DNA ploidy, and MVD had a significant impact on the survival of patients in univariate analysis. The 5-year survival rate in patients with a low MVD (11 or less) was 68.1% compared with 50.4% for those with a high MVD (greater than 11; P <0.01). Men had more vascular tumors than did women. Also, high-grade tumors had significantly higher vascular counts. In a Cox proportional hazard model, tumor angiogenesis sustained its significant impact on survival of the patients in addition to tumor stage and DNA ploidy.

Conclusions: These findings suggest that angiogenesis and DNA ploidy are independent additional prognostic factors in patients with squamous cell carcinoma of the urinary bladder.