Cyclooxygenase-2 expression in pretreatment biopsy as a predictor of tumor responses after preoperative chemoradiation in rectal cancer

Byung Soh Min, Yoon Jung Choi, Hong Ryull Pyo, Hogeun Kim, Jinsil Seong, Hyuncheol Chung, SunYoung Rha, Namkyu Kim

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Abstract

Objective: To determine whether cyclooxygenase-2 (COX-2) expression in pretreatment biopsy specimens is a useful predictive marker of tumor response to preoperative chemoradiation (CRT) in rectal cancer. Design: Case series. Setting: Colorectal cancer clinic. Patients: Thirty patients with locally advanced rectal cancer were given preoperative CRT of 5040 cGy for 6 weeks with concurrent administration of 5-fluorouracil and leucovorin. Main Outcome Measures: Immunohistochemical staining for COX-2 and angiogenesis markers (vascular endothelial growth factor, thymidine phosphorylase, and CD34) were performed on biopsy specimens obtained before preoperative CRT. The responses to preoperative CRT were assessed by radiologic downsizing (measured using magnetic resonance imaging volumetry), histopathologic downstaging, and a 3-point tumor regression grade (TRG) evaluation, based on the ratio of residual cancer to fibrosis. Results: Tumor downstaging was seen in 15 patients (50.0%) and nodal downstaging was noted in 14 patients (46.7%). Tumor regression grade 1 (good response) was shown by 7 patients (23.3%); TRG2 (moderate response) in 15 patients (50.0%); and TRG3 (poor response) in 8 patients (26.7%). Patients with COX-2 overexpression were more likely to show a poor TRG (P=.003) and were less likely to achieve histopathologic nodal downstaging (P=.03) than those with normal COX-2 expression. Vascular endothelial growth factor overexpression was found to be associated with COX-2 overexpression (P=.02). Conclusions: Overexpression of COX-2 in pretreatment biopsies might be predictive of poor tumor regression after preoperative CRT. Administration of COX-2 inhibitors to patients with COX-2 overexpression, in an attempt to improve response rate to preoperative CRT, warrants assessment in clinical trials.

Original languageEnglish
Pages (from-to)1091-1097
Number of pages7
JournalArchives of Surgery
Volume143
Issue number11
DOIs
Publication statusPublished - 2008 Nov 1

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Cyclooxygenase 2
Rectal Neoplasms
Biopsy
Neoplasms
Vascular Endothelial Growth Factor A
Thymidine Phosphorylase
Leucovorin
Cyclooxygenase 2 Inhibitors
Residual Neoplasm
Tumor Biomarkers
Fluorouracil
Colorectal Neoplasms
Fibrosis
Magnetic Resonance Imaging
Outcome Assessment (Health Care)
Clinical Trials
Staining and Labeling

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

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title = "Cyclooxygenase-2 expression in pretreatment biopsy as a predictor of tumor responses after preoperative chemoradiation in rectal cancer",
abstract = "Objective: To determine whether cyclooxygenase-2 (COX-2) expression in pretreatment biopsy specimens is a useful predictive marker of tumor response to preoperative chemoradiation (CRT) in rectal cancer. Design: Case series. Setting: Colorectal cancer clinic. Patients: Thirty patients with locally advanced rectal cancer were given preoperative CRT of 5040 cGy for 6 weeks with concurrent administration of 5-fluorouracil and leucovorin. Main Outcome Measures: Immunohistochemical staining for COX-2 and angiogenesis markers (vascular endothelial growth factor, thymidine phosphorylase, and CD34) were performed on biopsy specimens obtained before preoperative CRT. The responses to preoperative CRT were assessed by radiologic downsizing (measured using magnetic resonance imaging volumetry), histopathologic downstaging, and a 3-point tumor regression grade (TRG) evaluation, based on the ratio of residual cancer to fibrosis. Results: Tumor downstaging was seen in 15 patients (50.0{\%}) and nodal downstaging was noted in 14 patients (46.7{\%}). Tumor regression grade 1 (good response) was shown by 7 patients (23.3{\%}); TRG2 (moderate response) in 15 patients (50.0{\%}); and TRG3 (poor response) in 8 patients (26.7{\%}). Patients with COX-2 overexpression were more likely to show a poor TRG (P=.003) and were less likely to achieve histopathologic nodal downstaging (P=.03) than those with normal COX-2 expression. Vascular endothelial growth factor overexpression was found to be associated with COX-2 overexpression (P=.02). Conclusions: Overexpression of COX-2 in pretreatment biopsies might be predictive of poor tumor regression after preoperative CRT. Administration of COX-2 inhibitors to patients with COX-2 overexpression, in an attempt to improve response rate to preoperative CRT, warrants assessment in clinical trials.",
author = "Min, {Byung Soh} and Choi, {Yoon Jung} and Pyo, {Hong Ryull} and Hogeun Kim and Jinsil Seong and Hyuncheol Chung and SunYoung Rha and Namkyu Kim",
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Cyclooxygenase-2 expression in pretreatment biopsy as a predictor of tumor responses after preoperative chemoradiation in rectal cancer. / Min, Byung Soh; Choi, Yoon Jung; Pyo, Hong Ryull; Kim, Hogeun; Seong, Jinsil; Chung, Hyuncheol; Rha, SunYoung; Kim, Namkyu.

In: Archives of Surgery, Vol. 143, No. 11, 01.11.2008, p. 1091-1097.

Research output: Contribution to journalArticle

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T1 - Cyclooxygenase-2 expression in pretreatment biopsy as a predictor of tumor responses after preoperative chemoradiation in rectal cancer

AU - Min, Byung Soh

AU - Choi, Yoon Jung

AU - Pyo, Hong Ryull

AU - Kim, Hogeun

AU - Seong, Jinsil

AU - Chung, Hyuncheol

AU - Rha, SunYoung

AU - Kim, Namkyu

PY - 2008/11/1

Y1 - 2008/11/1

N2 - Objective: To determine whether cyclooxygenase-2 (COX-2) expression in pretreatment biopsy specimens is a useful predictive marker of tumor response to preoperative chemoradiation (CRT) in rectal cancer. Design: Case series. Setting: Colorectal cancer clinic. Patients: Thirty patients with locally advanced rectal cancer were given preoperative CRT of 5040 cGy for 6 weeks with concurrent administration of 5-fluorouracil and leucovorin. Main Outcome Measures: Immunohistochemical staining for COX-2 and angiogenesis markers (vascular endothelial growth factor, thymidine phosphorylase, and CD34) were performed on biopsy specimens obtained before preoperative CRT. The responses to preoperative CRT were assessed by radiologic downsizing (measured using magnetic resonance imaging volumetry), histopathologic downstaging, and a 3-point tumor regression grade (TRG) evaluation, based on the ratio of residual cancer to fibrosis. Results: Tumor downstaging was seen in 15 patients (50.0%) and nodal downstaging was noted in 14 patients (46.7%). Tumor regression grade 1 (good response) was shown by 7 patients (23.3%); TRG2 (moderate response) in 15 patients (50.0%); and TRG3 (poor response) in 8 patients (26.7%). Patients with COX-2 overexpression were more likely to show a poor TRG (P=.003) and were less likely to achieve histopathologic nodal downstaging (P=.03) than those with normal COX-2 expression. Vascular endothelial growth factor overexpression was found to be associated with COX-2 overexpression (P=.02). Conclusions: Overexpression of COX-2 in pretreatment biopsies might be predictive of poor tumor regression after preoperative CRT. Administration of COX-2 inhibitors to patients with COX-2 overexpression, in an attempt to improve response rate to preoperative CRT, warrants assessment in clinical trials.

AB - Objective: To determine whether cyclooxygenase-2 (COX-2) expression in pretreatment biopsy specimens is a useful predictive marker of tumor response to preoperative chemoradiation (CRT) in rectal cancer. Design: Case series. Setting: Colorectal cancer clinic. Patients: Thirty patients with locally advanced rectal cancer were given preoperative CRT of 5040 cGy for 6 weeks with concurrent administration of 5-fluorouracil and leucovorin. Main Outcome Measures: Immunohistochemical staining for COX-2 and angiogenesis markers (vascular endothelial growth factor, thymidine phosphorylase, and CD34) were performed on biopsy specimens obtained before preoperative CRT. The responses to preoperative CRT were assessed by radiologic downsizing (measured using magnetic resonance imaging volumetry), histopathologic downstaging, and a 3-point tumor regression grade (TRG) evaluation, based on the ratio of residual cancer to fibrosis. Results: Tumor downstaging was seen in 15 patients (50.0%) and nodal downstaging was noted in 14 patients (46.7%). Tumor regression grade 1 (good response) was shown by 7 patients (23.3%); TRG2 (moderate response) in 15 patients (50.0%); and TRG3 (poor response) in 8 patients (26.7%). Patients with COX-2 overexpression were more likely to show a poor TRG (P=.003) and were less likely to achieve histopathologic nodal downstaging (P=.03) than those with normal COX-2 expression. Vascular endothelial growth factor overexpression was found to be associated with COX-2 overexpression (P=.02). Conclusions: Overexpression of COX-2 in pretreatment biopsies might be predictive of poor tumor regression after preoperative CRT. Administration of COX-2 inhibitors to patients with COX-2 overexpression, in an attempt to improve response rate to preoperative CRT, warrants assessment in clinical trials.

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