title: Improved cancer specific-survival in patients with carcinoma invading bladder muscle expressing cyclo-oxygenase-2.
abstract: Study Type - Prognosis (case series).
  
  
  METHODS
  4 OBJECTIVE: To determine whether the expression of cyclo-oxygenase (COX)-2 has an influence on survival and on the response to chemotherapy in invasive bladder cancer.
  
  
  METHODS
  A population of 266 patients from a tertiary university centre with carcinoma invading bladder muscle without evidence of metastasis at time of cystectomy was analyzed retrospectively. COX-2 expression was evaluated immunohistochemically with a monoclonal anti-COX-2 antibody. All pertinent clinical and pathological parameters were reviewed and correlated with risk factors influencing outcome, including disease-specific and overall survival, as well as COX-2 expression. Immunoreactivity was categorized as positive if COX-2 staining was present in >5% tumour cells.
  
  
  RESULTS
  The expression of COX-2 was not influenced by tumour stage, grade or nodal status, nor any other parameters. The risk factors that influenced disease-specific survival in carcinoma invading bladder muscle on multivariate analysis were lymph node status (hazards ratio, HR = 2.46 for N1, P = 0.001, HR = 2.90 for N2, P < 0.001, HR = 5.19 for N3, P = 0.012), use of neoadjuvant chemotherapy (HR = 3.54; P= 0.004) or adjuvant chemotherapy (HR = 0.57, P = 0.014) and COX-2 expression (HR = 0.64 if >5% cells had positive expression; P = 0.025). Kaplan-Meier analysis showed an increased disease-specific survival (P = 0.0063), as well as longer recurrence-free survival (P = 0.003), in patients with muscle-invasive bladder tumours expressing COX-2 in >5% of the cells. A tendency was also observed in a subgroup with positive nodes treated with adjuvant chemotherapy (P = 0.093).
  
  
  CONCLUSIONS
  The overexpression of COX-2 is associated with a better recurrence-free and disease-specific survival in a large cohort of 266 patients with carcinoma invading bladder muscle treated by cystectomy. A trend for increased disease-specific survival was also observed for patients with COX-2 overexpression and positive nodes who received adjuvant chemotherapy. Potential of COX-2 as a prognostic marker in bladder cancer should be considered.
authors.affiliation: Urology Service, Surgery Department Laboratoire d'Uro-Oncologie Expérimentale, CHUQ-Hôtel-Dieu de Québec, Quebec, Canada.
authors.forename: Anis
authors.initials: A
authors.lastname: Aziz
authors.forename: Annie
authors.initials: A
authors.lastname: Lessard
authors.forename: Katherine
authors.initials: K
authors.lastname: Moore
authors.forename: Hélène
authors.initials: H
authors.lastname: Hovington
authors.forename: Eva
authors.initials: E
authors.lastname: Latulippe
authors.forename: Hélène
authors.initials: H
authors.lastname: Larue
authors.forename: Yves
authors.initials: Y
authors.lastname: Fradet
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000201:enzymology / Q000401:mortality* / Q000473:pathology; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000201:enzymology / Q000401:mortality* / Q000473:pathology; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000201:enzymology / Q000401:mortality* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D051546:Cyclooxygenase 2