Prognostic significance of cyclooxygenase-2 in cervical cancer: A meta-analysis

Authors

  • Miaoling Huang,

    1. Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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  • Qing Chen,

    Corresponding author
    1. Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
    • Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
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    • Fax: +86-20-81332011

  • Jianpeng Xiao,

    1. Environment and Health Research Center, Guangdong Institute of Public Health, Guangzhou, Guangdong, China
    2. Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China
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  • Changhao Liu,

    1. Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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  • Xiaomiao Zhao

    1. Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Abstract

Published data on the prognostic value of cyclooxygenase-2 (COX-2) overexpression in cervical cancer are conflicting and heterogeneous. We performed a meta-analysis to more precisely estimate its prognostic significance. The pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were used to estimate the effects. Twenty-three studies with 1,477 cervical cancer patients were selected to evaluate the association between COX-2 and overall survival (OS), disease-free survival (DFS), response to chemoradiation (RC) and clinicopathological parameters. High COX-2 expression predicted poor OS (HR: 2.53, 95% CI: 1.54–4.18), DFS (HR: 2.41, 95% CI: 1.58–3.69) and RC (OR: 3.03, 95% CI: 1.97–4.64). Subgroup analyses showed that COX-2 overexpression was related significantly with poor OS in patients treated by chemoradiation or surgery, and in patients with squamous cell carcinoma, respectively. Besides, COX-2 overexpression was related significantly with poor DFS in chemoradiation subgroup. Furthermore, COX-2 overexpression was associated with poor RC in patients who received “FP” regimen or “P” regimen. Additionally, there were significant associations between COX-2 expression and all clinicopathological parameters except tumor grade. The pooled ORs (95% CI) were as follows: 1.49 (1.09–2.04) for age, 1.77 (1.22–2.56) for lymph node metastasis, 1.04 (0.74–1.47) for tumor grade, 1.71 (1.12–2.64) for tumor size, 2.38 (1.28–4.45) for FIGO stage, 3.96 (2.32–6.77) for histological type, 2.45(1.10–5.42) for parametrical involvement. This meta-analysis indicated that COX-2 overexpression might be an unfavorable prognostic and a chemoradiation resistance predictive factor for cervical cancer; it could potentially help to stratify patients further in clinical treatment.

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