Immunoreactivity was categorized as positive if COX-2 staining was present in > 5% tumour cells. RESULTSThe expression of COX-2 was not influenced by tumour stage, grade or nodal status, nor any other parameters. The risk factors that influenced disease-specific survival in carcinoma invading bladder muscle on multivariate analysis were lymph node status (hazards ratio, HR = 2.46 for N1, P = 0.001, HR = 2.90 for N2, P < 0.001, HR = 5.19 for N3, P = 0.012), use of neoadjuvant chemotherapy (HR = 3.54; P = 0.004) or adjuvant chemotherapy (HR = 0.57, P = 0.014) and COX-2 expression (HR = 0.64 if > 5% cells had positive expression; P = 0.025). Kaplan-Meier analysis showed an increased disease-specific survival ( P = 0.0063), as well as longer recurrence-free survival ( P = 0.003), in patients with muscleinvasive bladder tumours expressing COX-2 in > 5% of the cells. A tendency was also observed in a subgroup with positive nodes treated with adjuvant chemotherapy ( P = 0.093). CONCLUSIONS

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