Increased cyclooxygenase-2 expression is associated with better clinical outcome in patients submitted to complete ablation for severe endometriosis.
BACKGROUND
Recent studies have demonstrated the overexpression of cyclooxygenase-2 (COX-2) in endometriosis. The aim of this study was to investigate the correlation between COX-2 expression and the clinical outcome rate in a homogeneous series of patients undergoing fertility-sparing complete laparoscopic ablation for severe endometriosis.


METHODS
COX-2 expression was analysed by immunohistochemistry in 103 samples, 71 endometriomas (group 1) and 32 peritoneal implants and or recto-vaginal nodules (group 2) of endometriotic tissue from 85 patients submitted to complete laparoscopic ablation of severe endometriosis.


RESULTS
At median follow-up of 54 months, a recurrence rate of 24.7% (n = 21) was observed. Patients with COX-2-positive endometriotic cysts showed a lower relapse rate than COX-2-negative cases (16.7 versus 41.2%; P = 0.036). Patients with COX-2-positive peritoneal implant and or recto-vaginal nodule showed a similar trend. Taking the two groups of patients together, we found a significantly lower relapse rate in COX-2-positive patients in comparison to COX-2-negative patients (16.4 versus 40%; P = 0.0152). Moreover, COX-2-positive patients showed a longer relapse-free survival in comparison to COX-2-negative patients (P = 0.016).


CONCLUSIONS
In patients with severe endometriosis who underwent fertility-sparing complete ablation, COX-2 overexpression characterizes a subgroup of patients with lower risk of relapse and longer relapse-free survival.
Department of Oncology, Division of Gynaecologic Oncology, Catholic University of Sacred Heart, Campobasso, Italy.
Francesco
F
Fanfani
Anna
A
Fagotti
Gabriella
G
Ferrandina
Giuseppe
G
Bifulco
Francesco
F
Legge
Domenica
D
Lorusso
Luca
L
Minelli
Giovanni
G
Scambia
D000328:Adult; D051546:Cyclooxygenase 2 / Q000096:biosynthesis*; D018572:Disease-Free Survival; D004715:Endometriosis / Q000201:enzymology* / Q000601:surgery*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D015971:Gene Expression Regulation, Enzymologic; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000379:methods; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D051546:Cyclooxygenase 2