Introduction: The present study was designed to investigate the relationship between COX-2 gene expression, clinicopathological symptoms, and prognosis of patients with gastric cancer.
 Methods: The present cross-sectional study was designed to achieve the scientific aims among patients referred to the Imam Reza Hospital, Mashhad, Iran from 2008 to 2018. In this study, patients' demographic characteristics, clinical signs and symptoms, tumor findings, type of surgery, and COX-2 gene expression level (using Real Time PCR technique) were recorded. The data were analyzed by SPSS software (version 16), statistical tests, including Chi-square, Fisher's exact, Gamma coefficient, one-way ANOVA, or Kruskal-Wallis test at a significance level of 0.05.
 Results: Out of 110 patients included in the study, 55 patients were evaluated according to the criteria. Among them 21 (38.2%) patients had decreased levels of gene expression, in 18 (32.7%) patients gene expression was in the normal range, and in 16 (29.1%) patients increased gene expression was seen. The average survival months of patients after surgery were 23.41 ± 23.07 months. No statistically significant relationship was found between increased COX-2 gene expression and clinical signs, age, sex, survival (by month), tumor progression, type of surgery, histological features, family history of cancer, and other cases (P> 0.05); However, considering the annual survival in the annual classification showed a significant relationship with the expression of COX-2 gene (P=0.028).
 Conclusion: Despite no significant relationship between COX-2 gene expression and studied parameters in the patients with gastric cancer in this study, the existence of a significant relationship between gene expression and annual survival of patients seems so important.
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