Increased cyclooxygenase-2 expression is associated with chemotherapy resistance and poor survival in cervical cancer patients

Purpose: To investigate the expression of cyclooxygenase (COX-2) and its association with clinicopathologic parameters and clinical outcome in patients with cervical cancer. Patients and Methods: The study included 84 patients with stage IS to IVA cervical cancer. Patients with early-stage cases (n = 21) underwent radical surgery, whereas patients with locally advanced cervical cancer (LACC) (n = 63) were first administered neoadjuvant cisplatin-based treatment and subjected to surgery in case of response. Immunohistochemical analysis was performed on paraffin-embedded sections with rabbit antiserum against COX-2. Results: COX-2-integrated density values in the overall population ranged from 1.2 to 82.3, with mean +/- SE values of 27.4 +/- 2.4. According to the chosen cutoff value, 36 (42.9%) of 84 patients were scored as COX-2 positive. COX-2 levels were shown to be highly associated with tumor susceptibility to neoadjuvant treatment. COX-2 showed a progressive increase from mean +/- SE values of 19.9 +/- 8.0 in complete responders through 31.5 +/- 3.5 in partial responses to 44.8 +/- 3.9 in patients who were not responsive (P = .0054). When logistic regression was applied, only advanced stage and COX-2 positivity retained independent roles in predicting a poor chance of response to treatment. COX-2-positive patients had a shorter overall survival (OS) rate than COX-2-negative patients. In patients with LACC, the 2-year OS rate was 38% in COX-2-positive versus 85% in COX-2-negative patients (P = .0001). In the muitivariate analysis, only advanced stage and COX-2 positivity retained independent negative prognostic roles for OS. Conclusion: The assessment of COX-2 status could provide additional information to identify patients with cervical cancer with a poor chance of response to neoadjuvant treatment and unfavorable prognosis. (C) 2002 by American Society of Clinical Oncology.