title: Lower cyclooxygenase-2 expression is associated with recurrence of solitary non-muscle invasive bladder carcinoma.
abstract: BACKGROUND
  A new modality is necessary to prevent recurrence of superficial bladder cancer after complete transurethral resection because of the high recurrence rate even with current prophylaxis protocols.
  
  
  METHODS
  In order to analyze the predictive value of cyclooxygenase-2 (COX-2) expression and tumor infiltrating lymphocytes (TILs) in recurrence of this disease tumor specimens from 127 patients with solitary papillary non-muscle invasive bladder cancer (NMIBC), 78 with recurrent disease and 49 without recurrence during follow up of minimum 5 years, were retrieved for tissue microarrays construction and immunohistochemical analysis. COX-2 expression was scored according to Allred's scoring protocol, while presence of TILs was categorized as absent (no) or present (yes) on whole tissue sections.
  
  
  RESULTS
  COX-2 immunoreactivity was presented in 70 (71%), weak in 16% and strong in 55% of cases, while 29 (29%) tumors were negative. TILs were present in 64 (58%) NMIBC, while 44 cases (41%) did not reveal mononuclear infiltration in tumoral stroma. Statistical analysis demonstrated a higher proportion of patients with recurrence in the group with the COX-2 score 0, and lower in the group with score 2 (p=0.0001, p=0.0101, respectively). In addition, a higher proportion of recurrent patients in the group with no TILs, and lower proportion in the group with TILs were found (p=0.009, p=0.009, respectively). Univariate and multivariate analysis revealed overexpression of COX-2 and presence of TILs as negative predictors.
  
  
  CONCLUSIONS
  Patients with lower COX-2 expression and absence of TILs in NMIBC need to be followed up more vigorously and probably selected for adjuvant therapy.
  The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1411318819790406.
authors.affiliation: Ultrasound Diagnostic Service, Health Centre Rijeka, Rijeka, Croatia. medicina_ri@inet.hr
authors.forename: Tomislav
authors.initials: T
authors.lastname: Tadin
authors.forename: Kristian
authors.initials: K
authors.lastname: Krpina
authors.forename: Sanja
authors.initials: S
authors.lastname: Stifter
authors.forename: Emina
authors.initials: E
authors.lastname: Babarović
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Fučkar
authors.forename: Nives
authors.initials: N
authors.lastname: Jonjić
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D002291:Carcinoma, Papillary / Q000201:enzymology* / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D051546:Cyclooxygenase 2 / Q000032:analysis*; D015536:Down-Regulation; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D016246:Lymphocytes, Tumor-Infiltrating / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000201:enzymology* / Q000473:pathology; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors; D046888:Tissue Array Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human