| Objective:Intratumoral microvascular density (MVD) has been controversial as an indicator of prognosis in bladder transitional cell carcinoma(BTCC). Classification of the intratumoral blood vessels based on differential expressions of blood vessel markers has not been correlated with patient prognosis in BTCC. In this study,paraffin-embedded BTCC tissues were used in tissue microarray analyse and conventional section analyse. By observing different microvascular morphological features and the expression of specific blood vessel markers, we analyzed the classi- fication of tumor microvascular. We aimed to evaluate the association of different categories of blood vessels with the patients'outcomes for clinical reference.Methods:46 bladder cancer patients were filtered out in the exper- imental group,who were with no chemotherapy or radiationtherapy or immunotherapy history before the surgical treatment.And after pathology they were confirmed to be bladder transitional cell carcinoma. There were thirty-eight male patients and eight female patients, aged 60～81 years, with an average age of 72.2. 20 cases of bladder transitional cell carcinoma samples were accessed in the process of open surgery and 26 cases of samples were accessed in the process of Pathological examination. Control group were 16 cases of non-malignant bladder mucosa, and they were avoided organizations damaged to cause false impression. All Samples were fixed, and embedded in paraffin,HE staining and use of monoclonal antibody CD31, CD34, CD105, Smooth muscle actin by immunohistochemical evaluation.They were used in tissue microarray analyses and conventional section analyses. The characteristics of intratumoral blood vessels were identified by multiple blood vessel markers and pericyte markers. With known bladder transitional cell carcinoma of CD34, CD31 biopsy as a positive control, and PBS insteaded of primary antibody as a negative control. A computerized image analysis program was used to quantitatively calculate the vascular density. By computer image analysis software,we analyze the relationship of transitional cell carcinoma of the bladder and the clinical features.Results: Stained sections were observed by light microscope ,and then semi-determinalion was performed with an image analysis system :(1)Two distinct types of microvessels were identified in bladder transitional cell carcinoma(BTCC): undifferentiated (CD31+/CD34-) and differentiated (CD34+) vessels.(2)A higher undifferentiated MVD significantly correlated with higher tumor grade.The undifferentiated MVD in control group is 7±1.5; The undifferentiated MVD in transitional cell carcinoma of bladder grade I group is 12±4.2; the undifferentiated MVD in transitional cell carcinoma of bladder grade II group is 25±5.7; the undifferentiated MVD in transitional cell carcinoma of bladder grade III group is 40±5.1 .There has significant difference(P<0.01).(3)In tumor vasculature,CD105 was only expressed in the CD34+ (differentiated)blood vessels. These two markers identified almost the same quantity of differentiated tumor blood vessels. There has no significant difference between CD34+MVD and CD105+MVD(P>0.05).(4)The median was used as the cutoff point to divide the 46 patients into high-MVD and low-MVD groups, and there has significant difference of survival rate between the two groups(P<0.01).Conclusion:(1)Two distinct types of microvessels were identified in bladder transitional cell carcinoma.(2)Multivariate analyses showed that undifferentiated MVD was an independent prognostic factor for patient survival.
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