title: Cox-2 and its association with prognostic factors and response to primary chemotherapy in patients with breast cancer.
abstract: OBJECTIVE
  To evaluate the immunohistochemical expression of cox-2 before primary chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and its association with initial tumor size, lymph node status, hormone receptors, expression of HER2 and the clinical and pathological response in patients with breast cancer.
  
  
  METHODS
  We conducted a retrospective study with 41 women with histopathological diagnosis of ductal breast carcinoma. They underwent primary chemotherapy with FEC regimen (5-fluorouracil, epirubicin and cyclophosphamide) at 500mg/m2, 75mg/m2 and 500 mg/m2, respectively. Inclusion criteria were age range between 30 and 70 years, stage II to IIIA, absence of metastasis, primary tumor of the breast, single, unilateral, with ductal invasion at histology and absence of heart disease and pregnancy. To evaluate the expression of HER2/neu protein we used rabbit monoclonal antibodies. To visualize the expression of cox-2 protein we used polyclonal antibodies obtained from goats' serum. The evaluation of clinical response to treatment was performed during physical examination by measuring the major tumor axis with a pachymeter. Measurements were taken at admission and after primary chemotherapy cycles. After three chemotherapy sessions at intervals of 21 days the surgical procedure was carried out. We adopted the criteria of RECIST. After the operation we evaluated the local pathological response, which was considered complete when there was absence of invasive neoplasia and of the in situ component. In immunohistochemical assessing of estrogen receptors we used estrogen receptor NCL-ER6F11 and, for progesterone, progesterone receptor NCL-PGR-312, considering positive the staining of 10% or more tumor cells.
  
  
  RESULTS
  The distribution according to UICC clinical stage classified six patients in stage IIA (14.6%), 22 in stage IIB (53.6%) and 13 stage IIIA (31.8%). The initial clinical evaluation of the major tumor axis ranged from 2.5 to 15 cm and a median of 5 cm. We identified 14 patients (34.1%) with negative lymph node status, and 27 positive (65.9%). It was observed that 19 (46.3%) were in premenopause and 22 (53.6%) in menopause.
  
  
  CONCLUSIONS
  There was an association of the expression of Cox-2 to the factors associated with poor prognosis in breast cancer, such as positive lymph node status, negative hormone receptors and HER2 expression.
authors.affiliation: Clinica de Oncologia Pélvica do DOGI, Irmandade da Santa Casa de São Paulo, São Paulo, SP, Brazil. rozenowicz.r@uol.com.br
authors.forename: Renato de Lima
authors.initials: Rde L
authors.lastname: Rozenowicz
authors.forename: Roberto Euzébio dos
authors.initials: RE
authors.lastname: Santos
authors.forename: Maria Antonieta Longo Galvão
authors.initials: MA
authors.lastname: Silva
authors.forename: Fabio Francisco Oliveira
authors.initials: FF
authors.lastname: Rodrigues
authors.forename: André Lima de
authors.initials: AL
authors.lastname: Oliveira
authors.forename: Liliane Baratela
authors.initials: LB
authors.lastname: Ulson
authors.forename: Vilmar Marques
authors.initials: VM
authors.lastname: Oliveira
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Aoki
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000201:enzymology*; D018270:Carcinoma, Ductal, Breast / Q000201:enzymology* / Q000209:etiology*; D051546:Cyclooxygenase 2 / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D051546:Cyclooxygenase 2