Abstract
The prognostic significance of COX-2 in patients with breast cancer remains controversial. The aims of our meta-analysis are to evaluate its association with clinicopathological characteristics and prognostic value in patients with breast cancer. PubMed, EMBASE, Web of Science, the Ovid Database and Grey literature were systematically searched up to May 2016. Twenty-one studies including 6739 patients with breast cancer were analyzed. The meta-analysis indicated that the incidence difference of COX-2 expression was significant when comparing the lymph node positive group to negative group (OR = 1.76, 95% CI [1.30, 2.39]) and the tumor size ≥ 2cm group to the tumor size < 2cm group (OR = 1.71, 95% CI [1.22, 2.39]). None of other clinicopathological parameters such as the ER status, PR status, HER2 status and the vascular invasion status were associated with COX-2 overexpression. The detection of COX-2 was significantly correlated with the disease-free survival (DFS) of patients (HR = 1.58, 95% CI [1.23, 2.03]) and the overall survival (OS) of patients (HR = 1.51, 95% CI [1.31, 1.72]). Our meta-analysis demonstrates that the presence of high levels of COX-2 is associated with poor prognosis for breast cancer patients and predicts bigger tumor size and lymph node metastasis.
Highlights
As one of the most frequently diagnosed malignant tumor, breast cancer (BC) ranks first among female cancer deaths
Our meta-analysis demonstrates that the presence of high levels of COX-2 is associated with poor prognosis for breast cancer patients and predicts bigger tumor size and lymph node metastasis
When subgroup analyses were stratified by the statistical analysis methodology, our results demonstrated that higher COX-2 expression was significantly correlated with poor overall survival (OS) both by univariable analysis (HR: 1.63, 95% confidence interval (95% confidence intervals (CIs)): 1.14–2.31, P = 0.57) and multivariable analysis (HR: 1.48, 95% CI: 1.28–1.71, P = 0.28)
Summary
As one of the most frequently diagnosed malignant tumor, breast cancer (BC) ranks first among female cancer deaths. In 2015, for example, approximately 234,190 new cases in the USA diagnosed with breast cancer annually, with an estimated 40,730 deaths [1]. Despite the development of surgery and adjuvant chemotherapy has significantly improved the clinical survival for BC patients over past few years, the occurrence of breast cancer is still on the rise. The prognostic factors that have been implicated include human epidermal growth factor receptor (HER2), estrogen/ progesterone receptor (ER/ PR), tumor size, lymph nodes metastasis, and response to chemotherapy [2]. The mechanism of the clinical outcome in breast cancer patients has yet to be completely understood. Novel prognostic biomarkers and therapeutic targets are needed to be identified for the management of breast carcinoma
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