Cyclooxygenase-2 Expression in Intraepithelial Neoplasia and Squamous Cell Carcinoma of the Uterine Cervix and its Clinicopathological Relations

Background and Aim: Cyclooxygenase (COX)-2 is involved in the genesis of many tumors; multiple lines of evidence suggested that selective inhibitors of (COX-2) are a novel class of therapeutic and chemopreventive agents for epithelial malignancies. The aim of this study was to investigate the expression of COX-2 in cervical intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC) of the uterine cervix and its association with clinicopathological parameters. Patients and Methods: Twenty one patients with stage IIV SCC of the cervix, another 21 patients with CIN I-III and 6 patients with histologically normal cervices were included in this study. Patients in the SCC group were treated with radical hysterectomy plus pelvic and para-aortic lymphadenectomy or anterior pelvic exentration. Immunohistochemical study was performed on paraffin embedded tissue sectionswith COX-2 antibody. Results: Expression of COX-2 was demonstrated in SCC and CIN groups, while it was undetectable in normal cervices. In this study, the prevalence of positive COX-2 expression in SCC group was significantly higher than its prevalence in CIN group (66.7% Vs. 38.1%, p=0.03). Significantly higher expression of COX-2 was reported in patients with FIGO stage II-IV compared to patients with FIGO stage I (83.3% Vs. 44.4%, p=0.05). Additionally, patients with paramesial invasion had significantly higher COX-2 expression than patients without (90.0% Vs. 45.5%, p=0M). Furthermore, there was significant relationship with respect to COX-2 expression and lymph node involvement (p=0.04). Regarding the relation between COX-2 expression in both tumor cells and tumor associated tissue eosinophils (TATE), statistically significant inverse relation was reported (p=0.03). However, the statistical evaluation of COX-2 expression according to invasion (LVSI) and grade of differentiation demonstrated no significant relationship. Conclusions: Our results suggested that, COX-2 expression may have a role in the development and progression of CIN. COX-2 expression is related to most of clinicopathologic and prognostic variables of cervical carcinoma and may be incorporated into the criteria for determination of tumor aggressiveness. The role of COX-2 expression in cancer development and progression makes it a good target for therapy and selective COX-2 inhibitors may be a promising strategy not only for chemoprevention but also for therapeutic approaches in SCC of the uterine cervix.