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Clinical Cancer Research Vol. 7, 861-867, April 2001
© 2001 American Association for Cancer Research


Molecular Oncology, Markers, Clinical Correlates

Cyclooxygenase-2 Overexpression Is a Marker of Poor Prognosis in Stage I Non-Small Cell Lung Cancer1

Fadlo R. Khuri2, Hong Wu, J. Jack Lee, Bonnie L. Kemp, Reuben Lotan, Scott M. Lippman, Lei Feng, Waun K. Hong and Xiao-Chun Xu

Departments of Thoracic/Head and Neck Medical Oncology [F. R. K., R. L., S. M. L., W. K. H.] Biostatistics [J. J. L., L. F.], Pathology [B. L. K.], and Clinical Cancer Prevention [H. W., S. M. L., X-C. X.], The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030

Cyclooxygenase-2 (COX-2), the enzyme that converts arachidonic acid to prostaglandins, is overexpressed in a variety of different tumors, including those of the colon, pancreas, lung, and head and neck. We used in situ hybridization with a digoxgenin-labeled COX-2 antisense riboprobe to assess the presence of strong or intermediate versus weak or absent COX-2 expression in specimens from 160 patients with stage I non-small cell lung cancer (NSCLC). Of these, 3 specimens had strong expression, 69 had intermediate expression of COX-2, 24 had weak expression, and 64 had no detectable COX-2. The strength of COX-2 expression was associated with a worse overall survival rate (P = 0.001) and a worse disease-free survival rate (P = 0.022). The median survival times for the strong, intermediate or weak, and null COX-2 expressors were 1.04, 5.50, and 8.54 years, respectively. Interestingly, all three specimens with strong COX-2 expression came from patients who died within 18 months. Retinoic acid receptor ß (RAR-ß) is a nuclear retinoid receptor whose expression is frequently lost in aerodigestive tract carcinogenesis. We previously demonstrated that expression of RAR-ß in stage I NSCLC indicates a poor prognosis. Retinoids have been shown to prevent induction of COX-2 by mitogens and tumor promoters. Expression of COX-2 correlated with RAR-ß expression (P = 0.053), but not with k-ras mutational status, vascular endothelial growth factor, basic fibroblast growth factor, interleukin 8 levels, or other markers of angiogenesis, invasion, and metastases. Thus, like RAR-ß positivity, COX-2 overexpression appears to portend a shorter survival among patients with early stage non-small cell lung cancer. Future studies of RAR-ß and COX-2 regulation in NSCLC should further the development of prevention and therapy interventions with retinoids and/or COX-2 antagonists in this patient population.




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