| Bladder cancer is the most popular malignant tumor in urinary system and transitional cell carcinoma (TCC) is the most common pathological type of it. Histopathological grade and stage are still the most important indexes to predict tumor recurrence and prognosis. However, tumor stage and grade may lead clinician to a wrong way sometimes because of the biological heterogeneity of bladder TCC. Most of the studies about platelet-derived endothelial cell growth factor (PD-ECGF), which has been proved to be an angiogenic factor, showed correlation with tumor grade, relapse and prognosis in bladder TCC. But the relationship of PD-ECGF with tumor angiogenesis and invasion is still unknown.Formalin fixed, paraffin embedded specimens from 52 bladder TCC were immunostained for PD-ECGF, VEGF and vwF as a marker for vascular endothelial cells. The correlation of clinical and pathological characteristics of bladder TCC with expression of PD-ECGF and VEGF and microvessel density (MVD) was analyzed.Materials and MethodsPatients: Paraffin embedded specimens from 52 patients who underwent operation for bladder TCC in the first affiliated hospital of Zhejiang University medical school between 1994 and 1995 was selected for this experiment. 37 Cases were male and 15were female. The mean age was 62.8 years (range, 30~79years). 32 Specimens were obtained from TURBt, 19 from partial cystectomy and 1 from radical cystectomy. Among these specimens, 32 were single tumors and 20 multiple ones, 35 primary tumors and 17 secondary ones. The histopathological stage was determined obeying to the WHO standard, 17 for Gt, 27 for G2 and 8 for G3. According to UICC standard, the clinical stage was Tis~Tl in 30 specimens, T2 in 18, T3 in 2 and T4 in 2. 8 Nonneoplastic bladder mucosa specimens obtained from 6 BPH patients and 2 men underwent accidental death served as matched control, whose mean age was 64.4 years (range, 32~75 years).Follow-up: All cases were followed up by interview or by phone call. 49 Cases have got complete prognostic data, 28 cases underwent recurrence and 10 cases died within 5 years.5 Years tumor free survival rate was 42.9% and overall survival rate was 79.6%.Laboratory experiment: Expression of PD-ECGF, VEGF and MVD was detected in 52 pieces of bladder TCC specimens by Envision immunohistochemical staining.Determination of Immunostaining Outcome: Gross brown granules can be caught in cytoplasm or nuclei in positive cells of PD-ECGF or VEGF. The immunostaining outcome was detected by ratio of positive cells to all tumor cells in whole piece of immunostained slice, as well as intensity of staining, as follows: no cells stained in slice to be 0, <25% to be 1,26-50% to be 2, >50% to be 3, unstained to be 0, faint stained to be 1, median to be 2, heavy stained to be 3. Two scores adding to be not less than 4 is delimited to be the positive. Counting the microvessels under 5 high microscopy fields (400 X) of hot area, take the mean value as MVD.Statistical analysis: All data was processed with SPSS 10.0 software bag on DURON 700 personal computer. Enumeration data checked by Chi-squre Test,measurement data by Nonparametric Test. Multiple Factors Regression Analysis employed Cox model.Results1. Expression of PD-ECOF in bladder TCC and nonneoplastic bladder mucosa.Positive PD-ECGF expression was detected in 26(50%) of 52 bladder TCC, while 8 nonneoplastic bladder mucosa were all negative (P<0.01).2. Correlation of PD-ECGF with clinical stage and pathological grade of bladderTCC.Expression of PD-ECGF in tumors of high grade was significantly higher than low grade ones (P<0.01). It increased with tumor stage developing, but no significant difference was found (P>0.05). We divided all cases into two groups of Tis~T2 and T3-T4, and found significant difference in expression of PD-ECGF (P<0.05). No correlation was found between PD-ECGF and tumors number or primary/secondary occurrence (P>0.05). Tumors that underwent recurrence within 5 years have significantly higher express...
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