Cyclooxygenase-2 Expression in Cervical Squamous Cell Carcinoma: the Significance of Expression in Neoplastic Cells within the Lymphovascular Space

Abstract

<b>Background:</b> Cyclooxygenase-2 (COX-2) activity is related to the development and progression of cervicalcancer. Previous studies have shown that COX-2 expression in early stage (stage IB-IIA) cervical squamous cellcarcinoma is associated with lymph node metastasis in tumors with lymphovascular space invasion (LVSI), andthat COX-2 expression may facilitate lymph node metastasis after LVSI occurs. In this study, we evaluatedwhether COX-2 expression of neoplastic cells within lymphovascular spaces (tumor emboli) would provideadditional prognostic information. <br/><b>Methods</b>: Immunohistochemical stained slides for COX-2 on 150 cases ofstage IB-IIA cervical squamous cell carcinoma with LVSI were evaluated for expression of COX-2 in tumoremboli. Results were correlated with overall COX-2 expression of tumor and clinicopathologic features usingstatistical analysis. <br/><b>Results</b>: Expression of COX-2 was detected in 49.3% of cases. Expression of COX-2 intumor emboli (LV-COX-2 expression) was identified in 61 cases (40.7%). LV-COX-2 expression was associatedwith high LVSI count (p<0.001) and had a marginal association with tumor COX-2 expression (p=0.050) andlymph node metastasis (p=0.063). In tumors showing high LVSI count, LV-COX-2 expression was an independentpredictor for lymph node metastasis (p=0.038, 95% CI=1.030-2.725) whereas tumor COX-2 expression (p=0.550)was not. <br/><b>Conclusion</b>: Evaluation of COX-2 expression in tumor emboli may provide additional prognostic valuefor lymph node metastasis in cervical squamous cell carcinomas with a high LVSI count.