COX2 expression, angiogenesis, proliferation and survival in Barrettʹs cancer

Objectives To examine COX2 expression and its relation to angiogenesis, Ki67 and Bcl2 expression in Barrettʹs cancer. Methods Specimens from 48 R0-resected Barrettʹs adenocarcinoma were immunostained for cyclooxygenase 2 (COX2), CD 31 and α-sm actin to discriminate between mature and immature vessels, Mib-1 and Bcl2. COX2 staining, angiogenesis, Ki67 expression and Bcl2 expression were also measured. Results COX2 expression was increased in 25 of 48 cases. There was no significant correlation between COX2 expression and age, sex and tumor differentiation. A significant association was found between lymph node positive cases and elevated COX2 expression (p=0.008). The percentage of Ki67 positive cancer cells was 43.8% (range 15.4–67.5%) in the low COX2 group and 57.8% (range 12.0–84.6%) in the high COX2 group. The difference was statistically significant (p=0.046). The median neovascularisation coefficient in the low COX2 group was 11.68 (range 8.22–43.64) and 25.47 (range 8–38.3) in the high COX2 group. The difference was statistically significant (p=0.012). A significant difference in survival was observed between patients in the COX2 low category when compared with the COX2 high category (log-rank test p=0.013). Conclusions Elevated COX2 expression is associated with lymph-node metastases and reduced survival in Barrettʹs cancer. This appears to be related to the induction of angiogenesis and proliferation.