Bladder cancer is the second most common
malignancy of the urogenital region. The majority of
bladder cancer deaths occur as a consequence of metastatic disease. Microvessel density (MVD), a
surrogate marker for angiogenesis, has been shown to be predictive of progression and poor prognosis. The aim of this study was to evaluate the predictive value and prognostic significance of angiogenesis in human
non muscle invasive bladder cancer (
NMIBC) treated by BCG
immunotherapy. The frozen sections of 28
non muscle invasive bladder cancer specimens were stained with CD34 antibody to label the vascular endothelium using the standard
streptavidin-
biotin immunoperoxidase method. Angiogenic activity was measured using microvessel count determined by the expression of vascular markers CD34.The prognostic significance of
tumor stage, grade, loci number,
tumor size, age and CD34 expression in determining the risk for recurrence was studied with both univariate and multivariate methods of analysis. According to univariate analysis of the prognostic significance for
tumor stage, grade,
tumor size, loci number, age and CD34 expression, in patients with
NMIBC, the pT1 stage and high grade seem to be associated in a statistically significant manner with higher risk for recurrence (P=0.004, P=0.004, respectively). In the other hand, multivariate Cox regression's analysis showed that microvessel density and multiplicity were independent predictor of recurrence after BCG
immunotherapy (p=0.016, p=0.032, respectively). This study provides strong evidence that CD34 MVD is associated with recurrence after BCG
immunotherapy. Independent studies, however, will be required on larger cohort to validate these findings.