COX-2 is associated with proliferation and apoptosis markers and serves as an independent prognostic factor in gastric cancer

Tumour Biol. 2010 Jan;31(1):1-7. doi: 10.1007/s13277-009-0001-4. Epub 2009 Dec 18.


Cyclooxygenase-2 (COX-2) is an important factor in gastric carcinogenesis, and COX-2 expression in gastric cancer patients correlates with prognosis. We have now studied the impact of COX-2 in comparison to six other tissue tumor markers, DNA index, and S-phase fraction (SPF) in a large series of gastric cancer specimens. From 342 consecutive patients, 337 archival tissue specimens were available for immunohistochemistry of COX-2, HuR, cyclin A, MMP-2, p53, p21, and Ki-67 and 313 for analysis of DNA index and S-phase fraction by flow cytometry. Associations between factors were assessed by chi-square test and survival analysis by the Kaplan-Meier method and Cox model. A significant association emerged between of COX-2 and p53 (p < 0.0001), Ki-67 (p = 0.013), DNA ploidy (p < 0.0001), and SPF (p < 0.0001). In an extended multivariate analysis, COX-2 and p53 expression were independent prognostic factors for poor survival, in addition to high stage and non-curative surgery. In gastric cancer, COX-2 expression associated with markers for apoptosis and proliferation, and furthermore, it was confirmed that COX-2 and p53 are strong prognostic indicators.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Apoptosis*
  • Cell Proliferation
  • Cyclooxygenase 2 / analysis*
  • Flow Cytometry
  • Humans
  • Immunohistochemistry
  • Ki-67 Antigen / analysis
  • Middle Aged
  • Prognosis
  • Stomach Neoplasms / enzymology*
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology
  • Tumor Suppressor Protein p53 / analysis


  • Ki-67 Antigen
  • Tumor Suppressor Protein p53
  • Cyclooxygenase 2
  • PTGS2 protein, human