title: Prognostic significance of tumor iNOS and COX-2 in stage III malignant cutaneous melanoma.
abstract: OBJECTIVE
  New prognostic markers are needed for malignant melanoma. Inducible nitric oxide synthase (iNOS) and cyclooxygenase type 2 (COX-2) have been described to correlate with progression of melanoma. Moreover, activating mutations in BRAF/NRAS oncogenes are often detected in melanoma. The BRAF/NRAS mutation status and expression of COX-2 and iNOS were examined to compare their prognostic value for overall survival (OS) in stage III malignant cutaneous melanoma.
  
  
  METHODS
  The expression of iNOS and COX-2 in metastatic lymph nodes from 21 rapidly progressing (OS from date of diagnosis of stage III disease < or =14 months) and 17 slowly progressing (OS > or =60 months) stage III cutaneous melanoma patients was examined by immunohistochemistry. The presence of BRAF/NRAS mutations was analyzed using direct DNA sequencing. Chi2 exact trend test and logistic regression analysis were used for statistical analysis.
  
  
  RESULTS
  Both iNOS (P = 0.002) and COX-2 (P = 0.048) alone significantly predicted OS. The BRAF/NRAS mutation status did not significantly differ between patient groups, although iNOS significantly (P = 0.013) correlated with BRAF mutation frequency. Furthermore, the odds ratio (OR) with respect to OS of iNOS (OR = 10.4) was higher than that of COX-2 (OR = 5.6) and was stable in the multivariate analysis of OS together with disease stage IIIB/C, ulceration, number of metastatic lymph nodes, and Breslow tumor thickness.
  
  
  CONCLUSIONS
  Our data show that iNOS is an independent and stronger prognostic factor for OS in stage III malignant cutaneous melanoma than COX-2.
authors.affiliation: Department of Oncology and Pathology, Cancer Center Karolinska, R8:01, Karolinska University Hospital, Karolinska Institutet, 171 76 Stockholm, Sweden.
authors.forename: C Christian
authors.initials: CC
authors.lastname: Johansson
authors.forename: Suzanne
authors.initials: S
authors.lastname: Egyházi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Masucci
authors.forename: Helena
authors.initials: H
authors.lastname: Harlin
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mougiakakos
authors.forename: Isabel
authors.initials: I
authors.lastname: Poschke
authors.forename: Bo
authors.initials: B
authors.lastname: Nilsson
authors.forename: Liss
authors.initials: L
authors.lastname: Garberg
authors.forename: Rainer
authors.initials: R
authors.lastname: Tuominen
authors.forename: Diana
authors.initials: D
authors.lastname: Linden
authors.forename: Marianne Frostvik
authors.initials: MF
authors.lastname: Stolt
authors.forename: Johan
authors.initials: J
authors.lastname: Hansson
authors.forename: Rolf
authors.initials: R
authors.lastname: Kiessling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D051546:Cyclooxygenase 2 / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000201:enzymology / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D009367:Neoplasm Staging; D052247:Nitric Oxide Synthase Type II / Q000096:biosynthesis*; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics* / Q000378:metabolism; D012878:Skin Neoplasms / Q000201:enzymology / Q000401:mortality / Q000473:pathology
chemical_list: C496319:NOS2 protein, human; D052247:Nitric Oxide Synthase Type II; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf