Association of cyclooxygenase-2 expression with prognosis of stage T1 grade 3 bladder cancer.
OBJECTIVE
To determine whether the expression of cyclooxygenase-2 (COX-2) has prognostic significance in Stage T1G3 transitional cell carcinoma of the bladder, the most unfavorable subgroup in terms of recurrence and disease progression.


METHODS
Thirty-seven consecutive patients with initial T1G3 transitional cell carcinoma, who had undergone complete transurethral resection, followed by 6 weeks of intravesical instillation of bacille Calmette-Guérin (BCG), and with at least 1 year of follow-up, were enrolled in the study. Paraffin-embedded cancer tissue samples were immunohistochemically stained for COX-2, and possible correlations with clinicopathologic features, such as age, shape and multiplicity of tumor, recurrence, and progression were examined.


RESULTS
The median follow-up was 27 months (range 12 to 67). Sixteen patients (43.2%) experienced recurrence and 6 (16.2%) had progression defined as muscle invasion. Of 37 specimens, 16 (43.2%) stained positive for COX-2, defined as 5% or greater of positively stained cancer cells. COX-2 expression was statistically significant in predicting both recurrence (P = 0.0493) and disease progression (P = 0.0272). Patient age and the shape and multiplicity of tumors were not significantly predictive of recurrence or progression.


CONCLUSIONS
In a pathologically homogeneous group of T1G3 transitional cell carcinoma of the bladder, the expression of COX-2 correlated with recurrence and progression. Thus, patients with COX-2 positive superficial bladder cancer may need to be followed up more vigorously. Additional studies on the mechanistic implications of COX-2 with respect to recurrence and progression and the possible application of a COX-2 inhibitor to prevent recurrence and progression of superficial bladder cancer are warranted.
Kim
Sun I l
SI
Department of Urology and Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, South Korea.
Kwon
Soo Mee
SM
Kim
Young Sig
YS
Hong
Sung Joon
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000201:enzymology* / Q000473:pathology*; D051546:Cyclooxygenase 2; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes / Q000032:analysis*; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009363:Neoplasm Proteins / Q000032:analysis*; D009364:Neoplasm Recurrence, Local / Q000201:enzymology; D009367:Neoplasm Staging; D011379:Prognosis; D011451:Prostaglandin-Endoperoxide Synthases / Q000032:analysis*; D001749:Urinary Bladder Neoplasms / Q000201:enzymology* / Q000473:pathology*
D007527:Isoenzymes; D008565:Membrane Proteins; D009363:Neoplasm Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases