Elevated cyclooxygenase-2 expression correlates with diminished survival in carcinoma of the cervix treated with radiotherapy

Int J Radiat Oncol Biol Phys. 2001 Apr 1;49(5):1213-7. doi: 10.1016/s0360-3016(00)01583-2.


Purpose: The purpose of this study was to examine the relationship between overall survival and prognostic factors in carcinoma of the cervix treated with radiation therapy. A clinicopathologic study was performed on 24 patients.

Methods and materials: Formalin-fixed, paraffin-embedded tumor biopsies were stained for Cyclooxygenase-2 (COX-2), Topoisomerase I, Topoisomerase II, and p53. Clinical factors such as stage, grade, tumor size, pre- and post-treatment hemoglobin level, and radiotherapy dose were also evaluated.

Results: Median follow-up was 75 months for living patients. The only immunohistochemical or clinical factor that was associated with improved survival was decreased COX-2 distribution staining. High COX-2 distribution staining was associated with decreased overall survival (p = 0.021) and decreased disease-free survival (p = 0.015) by log-rank comparison of Kaplan-Meier survival curves. The 5-year overall survival rates for tumors with low vs. high COX-2 distribution values were 75% and 35%, respectively. COX-2 staining intensity was found to correlate positively with tumor size (p = 0.022).

Conclusion: These findings indicate that increased expression of COX-2 portends a diminished survival in patients with invasive carcinoma of the cervix treated with radiotherapy. Because COX-2 is an early-response gene involved in angiogenesis and inducible by different stimuli, these data may indicate opportunity to intervene with specific inhibitors of COX-2 in carcinoma of the cervix.

MeSH terms

  • Adenocarcinoma / enzymology*
  • Adenocarcinoma / mortality*
  • Adenocarcinoma / radiotherapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / enzymology*
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / radiotherapy
  • Cyclooxygenase 2
  • Female
  • Humans
  • Isoenzymes / metabolism*
  • Membrane Proteins
  • Middle Aged
  • Neoplasm Proteins / metabolism*
  • Prognosis
  • Prostaglandin-Endoperoxide Synthases / metabolism*
  • Survival Rate
  • Uterine Cervical Neoplasms / enzymology*
  • Uterine Cervical Neoplasms / mortality*
  • Uterine Cervical Neoplasms / radiotherapy


  • Isoenzymes
  • Membrane Proteins
  • Neoplasm Proteins
  • Cyclooxygenase 2
  • PTGS2 protein, human
  • Prostaglandin-Endoperoxide Synthases