title: Quantitative assessment of the association of COX-2 (Cyclooxygenase-2) immunoexpression with prognosis in human osteosarcoma: a meta-analysis.
abstract: BACKGROUND
  Numerous studies examining the relationship between Cyclooxygenase-2 (COX-2) immunoexpression and clinical outcome in osteosarcoma patients have yielded inconclusive results.
  
  
  METHODS
  We accordingly conducted a meta-analysis of 9 studies (442 patients) that evaluated the correlation between COX-2 immunoexpression and clinical prognosis (death). Pooled odds ratios (OR) and risk ratios (RR) with 95% confidence intervals (95% CI) were calculated using the random-effects or fixed-effects model.
  
  
  RESULTS
  Meta-analysis showed no significant association between COX-2 positivity and age, gender, tumor location, histology, stage, metastasis or 90% necrosis. Conversely, COX-2 immunoexpression was associated with overall survival rate (RR=2.12; 95% CI: 1.10-3.74; P=0.009) and disease-free survival rate (RR=1.63; 95% CI: 1.17-2.28; P=0.004) at 2 years. Sensitivity analysis performed by omitting low quality studies showed that the pooled results were stable.
  
  
  CONCLUSIONS
  COX-2 positivity was associated with a lower 2-year overall survival rate and disease-free survival rate. COX-2 expression change is an independent prognostic factor in patients with osteosarcoma.
authors.affiliation: Division of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Division of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Maolin
authors.initials: M
authors.lastname: He
authors.affiliation: Division of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Zengming
authors.initials: Z
authors.lastname: Xiao
authors.affiliation: Division of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wu
authors.affiliation: Division of Spine and Osteopathy Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis / Q000378:metabolism*; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D002648:Child; D051546:Cyclooxygenase 2 / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D012516:Osteosarcoma / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human