Cyclooxygenase-2 immunohistochemical expression is associated with worse prognosis in breast cancer: Retrospective study and literature review

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Figure 1
- Cyclooxygenase-2 (COX-2) immunohistochemistry staining patterns in breast cancer. A) Strong COX-2 staining in breast cancer (40 X). B) Moderate COX-2 staining in breast cancer (40 X). C) Weak COX-2 staining in breast cancer (40 X).
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Figure 2
- Overall survival (OS) and disease-free survival (DFS) curves (Kaplan Meier) in relation to cyclooxygenase-2 (COX-2) immunoexpression in breast cancer patients (There is an association between COX-2 immunostaining and OS [log-rank: 4.136, p=0.042], and DFS [log-rank: 5.968, p=0.015]).

Table 1

- Clinicopathological parameters of tumors (N=570).

Parameters and total number of cases	n (%)	Coxa immunoexpression		P-values
Parameters and total number of cases	n (%)	Negative	Positive	P-values
Type of tissue
Breast cancer	570 (100)	331 (57.3)	239 (42.7)	0.034
Normal breast	52 (100)	38 (73.1)	14 (26.9)
Gender
Male	5 (0.9)	2 (40.0)	3 (60.0)	0.351^*
Female	565 (99.1)	329 (58.2)	236 (41.8)
Age
<50 years	312 (54.7)	186 (59.6)	126 (40.4)	0.240^*
≥50 years	258 (45.3)	145 (56.2)	113 (43.8)
Grade
Grade 1	95 (16.7)	64 (67.4)	31 (32.6)	0.193^*
Grade 2	285 (49.8)	160 (56.1)	125 (43.9)
Grade 3	190 (33.5)	107 (56.3)	83 (43.7)
Invasive ductal	489 (88.9)	290 (59.3)	199 (40.7)	0.130^*
Others	71 (11.1)	36 (50.7)	35 (49.3)
Tumor size (n=492)
<3	181 (36.8)	111 (61.3)	70 (38.7)	0.112
3-6	229 (46.5)	129 (56.3)	100 (43.7)
>7	82 (16.7)	39 (47.6)	43 (52.4)
Pathological stage (n=495)
Low stage	333 (67.3)	207 (62.2)	126 (37.8)	0.001^*
High stage	162 (32.7)	75 (46.3)	87 (53.7)
Nodal metastasis (n=478)
Negative	169 (35.4)	96 (56.8)	73 (43.2)	0.470^*
Positive	309 (64.6)	173 (56.0)	136 (44.0)
Distant metastasis (n=450)
Negative	389 (86.4)	237 (69.9)	152 (39.1)	0.003^*
Positive	61 (13.6)	25 (41.0)	36 (59.0)
Lymphovascular invasion (n=412)
Negative	225 (54.6)	138 (61.3)	87 (38.7)	0.034^*
Positive	187 (45.4)	97 (51.9)	90 (48.1)
Surgical margins (n=445)
Negative	377 (84.7)	217 (57.6)	160 (42.4)	0.999^*
Positive	68 (15.3)	39 (57.4)	29 (42.6)
Local disease recurrence (n=300)
Negative	220 (73.3)	132 (60.0)	88 (40.0)	0.072^*
Positive	80 (26.7)	39 (48.7)	41 (51.3)

Table 2

- Studies of cyclooxygenase-2 expression in breast cancer.

References	Normal breast tissues	BC tissues	Age	Tumor size	Histologic type	Grade	Stage	Lymph nodes metastasis	Distant metastasis	Lymphovascular invasion	Surgical margins	Disease recurrence	Survival
Present study	26.9%	42.7%	-	-	-	-	+	-	+	+	-	-	+
Chen et al¹⁷	16.7%	72.7%	-	-		+		+	+				+
Wang et al¹⁸	15.4%	78.9%	-	-		+		+	+	+			+
Muhammad et al¹⁹	44%	72.7%	-	+		+	+	+		+
Jana et al²⁰	0%	85 %	+	+		+	+	+
Bhutani et al²¹	72%	66%	-	-		+	+	-
Sharma et al²²	72%	66%	-	-		-		-
Tekin et al²³		67%	+	+		+		+		-
Nassar et al²⁴		86.0%	-	-	-	-	-	+		-
Ameen et al²⁵		48%	-	-	-	-	-	-		+
Solanki et al²⁶		58%		+			+	+		+
Gao et al²⁷		68.66%	-			+	+	-
Sicking et al²⁸		24.9%	-			+	-						+
Giaginis et al²⁹		76.9%	-	-	-	↓+	-	-					↓+
Simonsson et al³⁰		91%	+	-		↓+		-					-
Misron et al³¹		75%	-	-		↓+		-		-
Serra et al³²		66.9%	-	-			-	-					-
Aggarwal et al³³		70%				-	-	-	-			-