Cyclooxygenase-2 Expression in Postmastectomy Chest Wall Relapse

Abstract

Purpose: Cyclooxygenase-2 (COX-2) expression has been shown to be associated with radiation resistance, which theoretically could be overcome with the use of COX-2 inhibitors. The purpose of this study was to assess the prognostic significance and clinical correlations of COX-2 expression (COX) in a cohort of patients treated with radiation for postmastectomy chest wall relapse. Experimental Design: Between 1975 and 1999, 113 patients were treated for isolated postmastectomy chest wall relapse. All patients were treated with biopsy and/or excision of the chest wall recurrence followed by radiation therapy. Median follow-up was 10 years. All clinical data, including demographics, pathology, staging, receptor status, HER-2/neu status, and adjuvant therapy, were entered into a computerized database. Paraffin-embedded chest wall recurrence specimens were retrieved from 42 patients, of which 38 were evaluated, created into a tissue microarray, stained by immunohistochemical methods for COX, and graded 0 to 3+. A score of 2 to 3+ was considered positive. Results: Overall survival from original diagnosis for entire cohort was 44% at 10 years. Survival rate after chest wall recurrence was 28% at 10 years.The distant metastasis-free survival rate after chest wall recurrence was 40% at10 years. Local-regional control of disease was achieved in 79% at 10 years after chest wall recurrence. COX was considered positive in 13 of 38 cases. COX was inversely correlated with estrogen receptor (P = 0.045) and progesterone receptor (P = 0.028), and positively correlated with HER-2/neu (P = 0.003). COX was also associated with a shorter time to postmastectomy chest wall relapse. The distant metastasis-free rate for COX-negative patients was 70% at 10 years, compared with 31% at 10 years for COX-2^positive patients (P = 0.029). COX positive had a poorer local-regional progression-free rate of 19% at 10 years, compared with 81% at 10 years for COX negative. This was of high statistical significance with a P value of 0.003. Conclusions: Outcome following radiation therapy for postmastectomy chest wall relapse is relatively poor. Positive COX correlated with other markers of poor outcome, including a shorter time to local relapse, negative estrogen receptor/progesterone receptor, and positive Her-2/neu status. Positive COX correlated with higher distant metastasis and lower local-regional control of disease. If confirmed with larger studies, these data have implications with respect to the concurrent use of COX-2 inhibitors and radiation for postmastectomy chest wall relapse.Despite the increasing use of breast-conserving surgeries for breast cancer, mastectomy still plays a large role in primary and salvage treatment. Unfortunately, despite the attempted removal of all breast tissue during a mastectomy, local-regional recurrences still occur. About 10% to 20% of all patients develop a local recurrence, mostly within the boundaries of the chest wall, within a 10-year period despite achieving negative surgical margins (1 -8). Pr...

Prognostic influence of cyclooxygenase-2 protein and mRNA expression in node-negative breast cancer patients

“…In the present study we defined a COX-2 positive status only when staining intensity was scored 3, explaining why the detection rate was comparably low with 22.3%. This is similar to Kim and co-workers who regarded a staining intensity of 2 and 3 as positive [ 27 ]. In their study of postmastectomy chest wall relapse, COX-2 protein expression correlated with increased distant metastasis [ 27 ].…”

“…This is similar to Kim and co-workers who regarded a staining intensity of 2 and 3 as positive [ 27 ]. In their study of postmastectomy chest wall relapse, COX-2 protein expression correlated with increased distant metastasis [ 27 ]. In line with their findings, several other retrospective studies have reported that increased protein expression of COX-2 is a negative prognostic marker for increased metastasis or reduced overall survival in primary breast cancer [ 9 , 8 , 10 , 11 ].…”

The Yale University Experience of Early-Stage Invasive Lobular Carcinoma (ILC) and Invasive Ductal Carcinoma (IDC) Treated with Breast Conservation Treatment (BCT): Analysis of Clinical-Pathologic Features, Long-Term Outcomes, and Molecular Expression of COX-2, Bcl-2, and p53 as a Function of Histology

“…In the present study, we chose COX‐2, Bcl‐2, and p53 for their prognostic significance for long‐term outcomes. COX‐2 has been associated with aggressive breast cancer and poorer outcomes with respect to higher breast relapse and worse disease‐free and overall survival rates, particularly in estrogen‐dependent tumors (28,31). Bcl‐2 is a protein in the Bcl family associated with apoptosis, and its expression appears to be associated with higher breast recurrence (30,32,33).…”