Cyclooxygenase-2 (COX-2) as a Potential Prognostic Marker in Oral Squamous Cell Carcinoma: A Systematic Review and...

Oral squamous cell carcinoma (OSCC) is the predominant form of head and neck squamous cell carcinoma (HNSCC), accounting for most cancer-related deaths due to metastasis and recurrence. COX-2, an inflammatory biomarker encoded by prostaglandin-endoperoxide synthase 2 (PTGS2) gene, has been shown to play a significant role in the prognosis of OSCC. Herein, we performed this meta-analysis to evaluate COX-2 as a potential therapeutic target in OSCC.

PubMed, Embase, Web of Science, and Scopus databases were searched from inception to April 2024, to identify studies with Immunohistochemistry (IHC)-based quantification that measure the clinicopathological features and prognostic significance of COX-2 in OSCC. The role of COX-2 expression in OSCC was evaluated by pooled hazard ratios (HRs), odd ratios (ORs) and 95% confidence intervals (CIs). The meta-analysis was performed using the Review Manager (RevMan) version 5.4.1.

Ten studies were included in this review. High expression of COX-2 was significantly associated with poor prognosis, with overall survival and progression-free survival in patients with OSCC indicated by the pooled HR (HR 1.49, 95% Cl: 1.06-2.10) and (HR: 1.86, 95% CI: 1.21-2.87), respectively. Also, high COX-2 expression was significantly associated with advanced T stage (T3/T4) and TNM stage (ll/lV), as shown by the pooled OR (OR: 2.91, 95% Cl: 1.52-5.55) and (OR: 2.68, 95% CI: 1.43-5.02), respectively. However, there was no significant association between lymph node metastasis and high expression of COX-2 (pooled OR: 2.16, 95% Cl: 0.71-6.57).

In conclusion, the present evidence suggests a role of COX-2 overexpression as a prognostic biomarker and in targeted therapy of OSCC patients. Further studies on the role of COX-2 expression might provide a more profound insight into the mechanism of carcinogenesis in OSCC.