Elevated COX-2 expression in cervical carcinoma - Reduced cause-specific survival and pelvic control

The purpose of this study was to correlate the level of cyclooxygenase-2 (C OX-2) expression in carcinoma of the cervix with the clinical endpoints: lo cal control, cause-specific survival, and patterns of failure in patients t reated with radiotherapy. Formalin-fixed, paraffin-embedded tumor biopsies were stained for COX-2. Clinical factors such as stage, grade, tumor size, pre- and posttreatment hemoglobin level, and radiotherapy dose were also ev aluated. Actuarial local control rates and cause-specific survival were det ermined according to the Kaplan-Meier method. COX-2 distribution staining w as the only prognostic factor that was associated with local control and ca use-specific survival. High COX-2 distribution staining was associated with decreased local control and decreased cause-specific survival by log rank comparison of Kaplan-Meier survival curves. The 5-year cause-specific survi val rates for tumors with low versus high COX-2 distribution values were 90 % and 22%, respectively (p = 0.0003). Actuarial pelvic control at 5 years w as superior in patients with low COX-2 distribution staining (92%) compared With high staining (42%, p = 0.005). COX-2 staining intensity was found to correlate positively with tumor size (p = 0.02). These findings indicate t hat increased expression of COX-2 yields reduced pelvic control and cause-s pecific survival in patients with invasive carcinoma of the cervix treated with radiotherapy. Previously, inhibition of COX-2 has been demonstrated to sensitize tumors to radiation without effect on normal tissue. Taken toget her, these data may support a novel therapeutic application of COX-2 inhibi tors in the treatment of carcinoma of the cervix.