The prognostic value of cyclooxygenase-2 expression in patients with esophageal cancer: evidence from a meta-analysis

Abstract

Published studies have investigated the prognostic role of cyclooxygenase-2 (COX-2) expression in patients with esophageal cancer (EC), but the result remains controversial. Thus, this meta-analysis was conducted to comprehensively evaluate the impact of COX-2 expression on the prognostic value in patients with EC. Relevant studies were identified from PubMed, EMBASE, and Web of Science databases. Studies that detected the COX-2 expression by immunohistochemistry and evaluated the relationship between COX-2 expression and overall survival (OS) or clinicopathological parameters were used in our analysis. The summary hazard ratios (HRs) or odds ratios were calculated to assess the risk or hazard association. A total of 25 studies, which included 2,465 patients, were included in our meta-analysis. Our analysis suggested that overexpression of COX-2 was associated with poor OS (HR =1.60, 95% CI =1.32–1.94, P<0.001). Subgroup analyses by race, percentage of high/positive COX-2 expression, histology type, treatment, and sample size all suggested significant association. Moreover, overexpression of COX-2 was significantly associated with depth of invasion, lymph node metastasis, distant metastasis, and TNM stage. This meta-analysis suggested that overexpression of COX-2 might serve as a prognostic biomarker for EC. Large well-designed prospective studies are needed to confirm our conclusion.

High PTGS2 expression in post‐neoadjuvant chemotherapy‐treated oesophageal adenocarcinoma is associated with improved survival: a population‐based cohort study

“…26 Three of these studies found that high PTGS2 expression was associated with poorer overall survival, [16][17][18] consistent with a 2017 metaanalysis by Hu et al (pooled HR 2.13, 95% CI 1.62-2.79). 11 Of the two previous studies investigating cancer-specific survival, Prins et al found that, although PTGS2 expression was an independent predictor of poor overall survival, associations were nonsignificant in an analysis of cancer-specific survival after adjustment for confounders (HR 1.55, 95% CI 12 The differences in improved survival for patients with high PTGS2 expression tumours observed in this study contrast with previous evidence. This may be because all patients in our cohort underwent neoadjuvant chemotherapy, whereas previous studies all excluded patients who received any chemotherapy (Table 4).…”

“…Three of these studies found that high PTGS2 expression was associated with poorer overall survival, consistent with a 2017 meta‐analysis by Hu et al . (pooled HR 2.13, 95% CI 1.62–2.79) . Of the two previous studies investigating cancer‐specific survival, Prins et al .…”

“…6,7 Specifically, oesophageal cancer cells are known to have greater expression of PTGS2 than normal tissue. [8][9][10] Although the association between PTGS2 expression in oesophageal squamous cell carcinoma tissue and survival has been extensively studied, 11 few studies have investigated the adenocarcinoma subtype. Moreover, results are inconsistent, with four [12][13][14][15] of the seven studies finding that PTGS2 expression was not associated with survival, and the remaining three [16][17][18] studies finding that survival was worse with high PTGS2 expression.…”

Role of prostanoids in gastrointestinal cancer

“…Similarly, COX-2 overexpression is also observed in esophageal and gastric cancer (14,15). Elevation of COX-2 expression is also associated with a shorter survival time among patients with CRC and esophageal cancer (16,17). However, conflicting results have been reported in the association between COX-2 expression and survival in patients with GC (18).…”

Immunohistochemical detectability of cyclooxygenase‐2 expression in cells of human melanocytic skin lesions: A methodological review

“…In turn, the COX-2 peroxidase activity may contribute to production of mutagens ( Figure 1). [5][6][7][8] Enhanced COX-2 expression was demonstrated in various types of human malignancies: carcinomas of colon, 9,10 breast, 11,12 lung, 13,14 stomach, 15,16 esophagus, 17,18 pancreas, 19 bladder, 20 prostate, 21 ovary, 22,23 cervix, 24,25 osteosarcomas, 26,27 gliomas, 28,29 and Hodgkin lymphomas. 30 In most of the studies, it was shown that cancer progression is accompanied by an increase in COX-2 levels and may have prognostic potential.…”