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The role of cyclooxygenase 2 expression in stage II and stage III colon cancer survival.


Gray RT, Cantwell MM, Coleman HG, Loughrey MB, Bankhead P, McQuaid S, O’Neill RF, Arthur K, Cardwell CR, Johnston BT, James J, Hamilton P, Salto-Tellez M, Murray LJ.

Departments / Institutions

Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast

Publication Date

Autumn 2015


An association between overexpression of cyclooxgenase 2 (COX-2) and poor prognosis has been demonstrated in some but not all colon cancer observational studies. This study examines the role of COX-2 expression and survival in a population-based cohort of patients with stage II and III colon cancer.


Immunohistochemical expression of COX-2 (positive vs. negative) was assessed in tissue microarrays using digital immunoscoring from 665 stage II and III colon cancer patients undergoing surgical resection in the Belfast and South Eastern Health and Social Care Trusts (2004-2008). Five-year follow-up data were obtained through the Northern Ireland Cancer Registry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for colon cancer-specific survival (CSS) and overall survival (OS).


Medication history was available for n=545 (82.0%) patients and aspirin use within this subgroup was n=110 (20.2%). COX-2 positive cancers (p=0.02) and aspirin users (p=0.002) were slightly older but stage distribution was similar for these variables. COX-2 expression and aspirin use were not associated with improved CSS or OS after adjusting for age, gender and stage. CSS was improved amongst aspirin users with COX-2 positive tumours (HR 0.48, CI 0.25-0.95) but this finding was no longer statistically significant when adjuvant chemotherapy and co-morbidities were considered (HR 0.54, CI 0.26-1.12). Similar results were obtained for OS.


COX-2 expression does not appear to have prognostic or predictive potential within this population-based cohort of colon cancer.

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