Prognostic significance of cyclooxygenase-2 expression in patients with hepatocellular carcinoma: a meta-analysis.
BACKGROUND
Cyclooxygenase-2 (COX-2) is believed to be an important enzyme in the carcinogenesis of hepatocellular carcinoma (HCC). However, it is still controversial whether COX-2 expression can be regarded as a prognostic factor for HCC patients. We performed a systematic review and meta-analysis of studies assessing the clinical and prognostic significance of COX-2 expression in HCC.


METHODS
Identification and review of publications assessing clinical or prognostic significance of COX-2 expression in HCC until November 1, 2014. A meta-analysis was performed to clarify the association between COX-2 expression and clinical outcomes.


RESULTS
A total of 11 publications met the criteria and included 943 cases. Analysis of these data showed that COX-2 expression was not significantly correlated with capsular formation (OR = 0.84, 95% confidence interval (CI): 0.46-1.55,p= 0.58), tumor TNM stage (OR = 0.73, 95% CI: 0.23-2.33,p= 0.59), vascular invasion (OR = 1.04, 95% CI: 0.25-4.35,p= 0.96), tumor size (OR = 0.78, 95% CI: 0.21-2.86,p= 0.71), or tumor differentiation degree (OR = 1.08, 95% CI: 0.42-2.79,p= 0.87). However, in the identified studies, COX-2 expression was strongly associated with high alpha-fetoprotein level (OR = 1.83, 95% CI: 1.01-3.33,p= 0.05), HBsAg status (OR = 1.85, 95% CI: 1.13-3.03,p= 0.01), decreased overall survival (relative risk (RR): 1.54, 95% CI: 1.18-2.02,p= 0.001) and decreased disease-free survival (RR = 1.49, 95% CI: 1.22-1.81,p< 0.001).


CONCLUSIONS
This meta-analysis shows that COX-2 expression in HCC is associated with decreased overall and disease-free survival and thus marks a worse prognosis. Nevertheless, more large sample and well-designed studies are warranted to confirm this finding.
Department of General Surgery, First Affiliated Hospital, University of South China, Hengyang, China; Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Guodong
G
Chen
Department of Endocrinology, Hengyang Central Hospital, Hengyang, China.
Xiaoyan
X
Li
Department of General Surgery, First Affiliated Hospital, University of South China, Hengyang, China.
Jing
J
Yang
Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Jie
J
Li
Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Xia
X
Wang
Department of General Surgery, First Affiliated Hospital, University of South China, Hengyang, China.
Jun
J
He
Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Zonghai
Z
Huang
cyclooxygenase-2; hepatocellular carcinoma; meta-analysis; prognosis; survival
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