Abstract
Objective: Cyclooxygenase-2 (COX-2) is a critical enzyme associated with inflammation and tumorigenesis. Although several studies have compared the expression of COX-2 in endometrial cancer tissues and normal tissues, the results have been inconsistent thus far. This study aims to conduct a meta-analysis to elucidate the role of COX-2 in the determination of the risk, prognosis, and clinical features of endometrial cancer.Methods: We retrieved the suitable studies on the association between COX-2 expression and endometrial cancer from PubMed, EMBASE, and Web of Science databases that were published between 1999 and September 31st, 2019. The hazard ratio (HR) and 95% confidence intervals (CIs) were retrieved to assess the relationship between COX-2 expression and the prognosis of endometrial cancer. The odds ratio (OR) and 95% CIs were calculated to evaluate the correlation between COX-2 expression and the risk and clinical features of endometrial cancer.Results: To investigate the association between COX-2 expression and the susceptibility, clinical features, and prognosis of endometrial cancer, we performed a meta-analysis on data from selected studies that collectively involved 273 normal individuals and 1,376 patients with endometrial cancer. Overall, the pooled analysis indicated that COX-2 expression was significantly associated with susceptibility (Caucasians, OR = 3.94, 95% CI = 2.17–7.17, P < 0.05; Asians, OR = 20.51, 95% CI = 8.54–49.26, P < 0.05), cancer stage (OR = 3.01, 95% CI = 1.95–4.67, P < 0.05), myometrial invasion (OR = 1.59, 95% CI = 1.17–2.15, P < 0.05), lymph node metastasis (OR = 1.63, 95% CI = 1.18–2.26, P < 0.05), and prognosis (OR = 2.91, 95% CI = 1.17–4.66, P < 0.05) in endometrial cancer.Conclusions: Our findings suggested that COX-2 overexpression is significantly associated with poor prognosis and advanced clinical features in endometrial cancer. Therefore, COX-2 may function as an effective prognostic biomarker and a potential therapeutic target for endometrial cancer.
Highlights
Endometrial cancer is the most common gynecological cancer in developed countries, and the estimated mortality in the United States in 2017 was 10,920 [1, 2]
Irregular or post-menopausal bleeding can be an early symptom of endometrial cancer that should prompt women to seek medical review, facilitating the early detection and timely treatment of endometrial cancer
The inclusion criteria were as follows: 1) studies that assessed the relationship between COX-2 expression and endometrial cancer; 2) studies involving endometrial cancer patients who were diagnosed according to the relevant diagnostic criteria; 3) studies that had adequate data [COX-2 expression levels in case and control groups, hazard ratios (HR), and 95% confidence intervals (CI)] to estimate the pooled odds ratio (OR) and HR
Summary
Endometrial cancer is the most common gynecological cancer in developed countries, and the estimated mortality in the United States in 2017 was 10,920 [1, 2]. Irregular or post-menopausal bleeding can be an early symptom of endometrial cancer that should prompt women to seek medical review, facilitating the early detection and timely treatment of endometrial cancer. Many women still do present at an advanced stage. The mortality rate of endometrial cancer has increased rapidly in recent years [3, 4]. Several factors, including diagnosis at an older age, higher diagnostic rate of advancedstage cancer, high-risk histology, and the rapid progression of endometrial cancer, may attribute to the high mortality rate of endometrial cancer. Patients with advanced endometrial cancer frequently have poor outcome, largely due to a paucity of effective treatment options
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