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Abstract The study included 54 patients, 39 with bladder carcinoma and 15 with benign bladder lesions, addition 15 healthy volunteers were enrolled in the study. All were subjected to: serologic schistosomiasis antibody assay, urine cytology, detection of urinary HIF-1α, and detection of tissue CD34 in 30 malignant cases. Results of the current study revealed that the mean age of the bladder cancer was 61 ±10. There was significant correlation between cigarette smoking and bladder cancer (P≤ 0.012). Malignant cases revealed Bilharzial antibodies in 64%, and was statistically significante (P=0.001) between the three groups of the study (Malignant, benign and control). On the other hand, bilharzial antibodies was positive more than half the malignant group. The correlation of the frequency of malignancy with the different clinicopathological factors revealed association with male, positive smokers, positive bilharziasis, TCC type and grade III. Using ELISA assay, HIF-1α mean rank between the studied groups showed highly significant difference (P=0.000). In the present study CD34 expression did not show significant correlation with tumor grade and stage.This may be due to the limited number of cases. The overall sensitivity of urine cytology was 53.8%, while its specificity was 93.3% with 71% accuracy 91.3% PPV and 60.8% NPV.On the other hand, a sensitivity of 84.6% and specificity of 63.3% with 75.3% accuracy were observed for urinary HIF-1α. PPV was 75% and NPV was 76%. By combining urinary HIF-1α assayed and cytology, sensitivity increased significantly to be 94.8% and accuracy also increased to 82.6%.However specificity decreased to become 66.7%. Furthermore HIF-1α also proved to be a good urinary tumor marker for high grades and stages. Urinary HIF-1α showed marked differentiation between malignant, benign and healthy normal groups. The combined use of cytology and HIF-1α increases the sensitivity of urine cytology from 53.8% to 94.8% and accuracy from 71.0% to 82.6%. However their use in diagnosis of bladder cancer can not replace cystoscopy but it can decrease the number of cystoscopies during follow up and screen population at high risk for bladder cancer so we recommended their use with cystoscopy during follow up cases to detect any recurrence. |