title: Prognostic role of cyclooxygenase-2 in epithelial ovarian cancer: a meta-analysis of observational studies.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic significance of cyclooxygenase-2 (COX-2) on survival in patients with ovarian cancer by using a meta-analysis of observational studies.
  
  
  METHODS
  We searched Pubmed and Embase to retrieve observational studies evaluating the association between COX-2 status and survival in patients with ovarian cancer. Hazards ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.
  
  
  RESULTS
  A total of 17 studies were included in this meta-analysis to estimate the association between COX-2 and overall survival (OS), disease-free survival (DFS), response to chemotherapy (RC), and other clinical parameters. In a random-effects meta-analysis of 15 studies, higher COX-2 expression significantly predicted poor OS (death HR, 1.34; 95% CI, 1.05-1.71; I(2)=56.5%). A more prominent association was found between COX-2 expression and poor OS when studies with adjustment for age, stage, and histology were included (death HR, 1.65; 95% CI, 1.25-2.17; I(2)=0%). However, higher COX-2 expression was not significantly associated with poor DFS (recurrence HR, 1.36; 95% CI, 0.79-2.33; I(2)=53.6%) and RC (OR, 1.89; 95% CI, 0.85-4.21; I(2)=17.6%). There was a marginally significant association between COX-2 positivity and several clinical parameters such as age, stage, and histology. The pooled ORs of higher COX-2 expression were 1.75 (95% CI, 1.01-3.04) for advanced stages, 1.34 (95% CI, 0.97-1.85) for old age, and 1.42 (95% CI, 0.98-2.05) for serous cancer in histologic type, respectively.
  
  
  CONCLUSIONS
  The present meta-analysis suggests that higher COX-2 expression may be an independent risk factor for poor OS in patients with ovarian cancer.
authors: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors: Jung-Yun
authors: JY
authors: Lee
authors: Seung-Kwon
authors: SK
authors: Myung
authors: Yong-Sang
authors: YS
authors: Song
mesh_terms: D000077216:Carcinoma, Ovarian Epithelial; D051546:Cyclooxygenase 2 / Q000096:biosynthesis* / Q000378:metabolism; D005260:Female; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000201:enzymology*; D019370:Observation; D010051:Ovarian Neoplasms / Q000201:enzymology*; D011379:Prognosis
chemical_list: D051546:Cyclooxygenase 2