Khunamornpong Surapan, Settakorn Jongkolnee, Sukpan Kornkanok, Srisomboon Jatupol, Ruangvejvorachai Preecha, Thorner Paul S, Siriaunkgul Sumalee
Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Gynecol Oncol. 2009 Jan;112(1):241-7. doi: 10.1016/j.ygyno.2008.09.017. Epub 2008 Oct 31.
Previous studies have indicated that cyclooxygenase-2 (COX-2) activity is related to the development and progression of cervical cancer. In this study, we evaluated the association between COX-2 expression and specific clinicopathologic features in surgically-treated squamous cell carcinoma of the uterine cervix.
Immunohistochemical staining for COX-2 was performed on 196 cases of stage IB-IIA cervical squamous cell carcinoma. Results were correlated with the clinicopathologic features and disease-free survival using statistical analysis.
Expression of COX-2 was detected in 48.5% of cases. COX-2 expression was significantly associated with lymph node metastasis (p=0.045) but lacked significant correlation with tumour stage, size, histologic grade, deep stromal invasion, lymphovascular space invasion, and parametrial involvement. In multivariate analysis, only parametrial involvement and lymphovascular space invasion (LVSI) were independent predictors for lymph node metastasis (p=0.001 and 0.007, respectively). COX-2 expression was not associated with lymph node metastasis in the absence of parametrial involvement or LVSI. In the cases with LVSI, COX-2 expression was significantly associated with lymph node metastasis (p=0.03), although with marginal significance (p=0.068) in the multivariate analysis. COX-2 expression was not associated with a decrease in disease-free survival for patients overall (p=0.977). However, in patients who did not receive adjuvant treatment, COX-2 expression was significantly associated with decreased disease-free survival (p=0.008) and was a significant predictor of recurrence (p=0.014).
In this study, COX-2 expression was associated with lymph node metastasis in cervical squamous cell carcinoma, but this was linked to the presence of LVSI or parametrial involvement. This suggests that COX-2 expression may enhance lymph node metastasis after LVSI occurs. If so, immunohistochemical staining for COX-2 may provide additional prognostic information in LVSI-positive cases, in particular in patients who do not receive postoperative adjuvant treatment.
既往研究表明，环氧合酶-2（COX-2）活性与宫颈癌的发生和发展相关。在本研究中，我们评估了COX-2表达与手术治疗的子宫颈鳞状细胞癌特定临床病理特征之间的关联。
对196例IB-IIA期宫颈鳞状细胞癌进行COX-2免疫组织化学染色。使用统计分析将结果与临床病理特征和无病生存期相关联。
48.5%的病例检测到COX-2表达。COX-2表达与淋巴结转移显著相关（p=0.045），但与肿瘤分期、大小、组织学分级、深层间质浸润、淋巴管间隙浸润和宫旁组织受累无显著相关性。在多变量分析中，只有宫旁组织受累和淋巴管间隙浸润（LVSI）是淋巴结转移的独立预测因素（分别为p=0.001和0.007）。在没有宫旁组织受累或LVSI的情况下，COX-2表达与淋巴结转移无关。在有LVSI的病例中，COX-2表达与淋巴结转移显著相关（p=0.03），尽管在多变量分析中具有边缘显著性（p=0.068）。总体而言，COX-2表达与患者无病生存期的降低无关（p=0.977）。然而，在未接受辅助治疗的患者中，COX-2表达与无病生存期的降低显著相关（p=0.008），并且是复发的显著预测因素（p=0.014）。
在本研究中，COX-2表达与宫颈鳞状细胞癌的淋巴结转移相关，但这与LVSI或宫旁组织受累的存在有关。这表明COX-2表达可能在LVSI发生后增强淋巴结转移。如果是这样，COX-2免疫组织化学染色可能为LVSI阳性病例，特别是未接受术后辅助治疗的患者提供额外的预后信息。
