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Cyclooxygenase-2 Is an Independent Predictor of Poor Prognosis in Uterine Leiomyosarcomas
  1. Chae Hyeong Lee, MD*,
  2. Ju-Won Roh, PhD*,
  3. Jong-Sun Choi, MD,
  4. Sokbom Kang, PhD,
  5. In-Ae Park, PhD§,
  6. Hyun Hoon Chung, MD,
  7. Yong-Tark Jeon, PhD,
  8. Jae Weon Kim, PhD,
  9. Noh-Hyun Park, PhD,
  10. Soon-Beom Kang, PhD and
  11. Yong-Sang Song, PhD
  1. * Departments of Obstetrics and Gynecology and
  2. Pathology, College of Medicine, Dongguk University, Seoul;
  3. Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do; and Departments of
  4. § Pathology and
  5. Obstetrics and Gynecology, College of Medicine, and
  6. Department of Obstetrics and Gynecology, Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea.
  1. Address correspondence and reprint requests to Yong-Sang Song, PhD, Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul, 110-744, Republic of Korea. E-mail: yssong{at}


Introduction: Cyclooxygenase-2 (COX-2) is a well-known enzyme that promotes tumor growth and metastasis. Cyclooxygenase-2 is upregulated in a number of human epithelial tumors, but data about the significance of COX-2 in mesenchymal tumors are lacking. The purpose of this study was to determine COX-2 expression in uterine sarcomas and whether a relationship exists between COX-2 expression and clinicopathologic outcomes.

Methods: Immunohistochemical staining for COX-2 was performed on paraffin-embedded tissue blocks of 49 uterine sarcomas (30 leiomyosarcomas, 14 endometrial stromal sarcomas, and 5 carcinosarcomas). Positive staining was defined as moderate or strong staining in 5% or more of tumor cells.

Results: Four of 30 leiomyosarcomas, 1 of 14 endometrial stromal sarcomas, and 2 of 5 carcinosarcomas were positive for COX-2 expression. In leiomyosarcomas, COX-2 expression correlated with tumor stage with marginal significance (P = 0.058). Patients with leiomyosarcoma positive for COX-2 expression had a lower overall survival rate than those without COX-2 expression (P = 0.025). In the multivariate Cox proportional hazards regression model, COX-2 expression, tumor stage, and mitotic count were independently associated with overall survival in leiomyosarcomas.

Conclusions: Our data suggest that immunohistochemically determined COX-2 expression is an independent prognostic factor in uterine leiomyosarcomas. Assessment of COX-2 status might be useful for determining the prognosis in patients with uterine leiomyosarcomas.

  • Cyclooxygenase-2
  • Uterine sarcoma
  • Uterine leiomyosarcoma
  • Survival

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