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Cyclooxygenase-2 expression in postmastectomy chest wall relapse.
Janet H Kim1, Veerle Bossuyt, Teresa Ponn
1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.
Summary
Cyclooxygenase-2 (COX-2) expression is linked to poorer outcomes in patients with postmastectomy chest wall relapse treated with radiation. Positive COX-2 correlates with increased distant metastasis and reduced local control, suggesting potential therapeutic implications.
Area of Science:
- Oncology
- Radiation Oncology
- Molecular Biology
Background:
- Cyclooxygenase-2 (COX-2) expression is implicated in radiation resistance.
- COX-2 inhibitors are theoretically beneficial for overcoming this resistance.
- Understanding COX-2's prognostic role in postmastectomy chest wall relapse is crucial.
Purpose of the Study:
- To evaluate the prognostic significance of COX-2 expression in patients receiving radiation for postmastectomy chest wall relapse.
- To identify clinical correlations of COX-2 expression in this patient cohort.
Main Methods:
- Retrospective analysis of 113 patients treated for isolated postmastectomy chest wall relapse between 1975-1999.
- Immunohistochemical analysis of COX-2 expression in 38 available tissue specimens.
- Correlation of COX-2 status with clinical data, survival, and disease control rates.
Main Results:
- Positive COX-2 expression (13/38 cases) was inversely correlated with estrogen and progesterone receptors and positively with HER-2/neu.
- COX-2 positivity was associated with a shorter time to chest wall relapse.
- Distant metastasis-free survival at 10 years was 70% for COX-2 negative vs. 31% for COX-2 positive (P=0.029).
- Local-regional control at 10 years was 81% for COX-2 negative vs. 19% for COX-2 positive (P=0.003).
Conclusions:
- Postmastectomy chest wall relapse after radiation therapy has a poor prognosis.
- Positive COX-2 expression is a marker of poor outcome, associated with negative hormone receptor status and positive HER-2/neu.
- COX-2 positivity predicts higher distant metastasis and lower local-regional control, warranting further investigation of COX-2 inhibitors in combination with radiation.