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Objective: Cervical cancer is a major health problem for women. Concurrent Cisplatin-radiation therapy (CCRT) can improve survival, although result of treatment is still not satisfactory. Many prognostic factors have been known, but they cannot explain all the results. Cyclooxygenase-2 (COX-2) is one of the molecular factors related to angiogenesis that can lead to more accurate predictive outcome and modification of the treatment in the future.
Methods: Retrospective study to find relationship of COX-2 expression to overall survival (OS), progression free survival (PFS), distant metastasis free survival (DMFS), and loco-regional relapse free survival (LRRFS) of locally advanced cervical cancer in patients who were treated with CCRT at Siriraj Hospital from 2002 to 2007. In this COX-2 IHC study, the interpretations of results were based on both intensity and quantity score.
Results: There were 49 patients included into the study. COX-2 was positive in 36 (73%). Median f/u time was 22 months. COX-2 expression was proven to be a significant prognostic factor to predict OS and PFS with HR 19.5 (95% CI 1.1-337.2) and HR 27.1 (95% CI 2.1-355.6) respectively. Total treatment time (>55 days) is the most significant prognostic factor for OS, PFS and DMF.
Conclusion: Expression of COX-2 positive is a significant prognostic factor to predict worse OS and PFS compared to COX-2 negative group in multivariate analysis. The COX-2 scoring system used in this study was good to predict prognosis.
Keywords: Locally advanced cervical cancer, expression of COX-2, prognosis factor, concurrent chemo-radiotherapy
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