The Prognostic Importance of EGFR and COX-2 Expression in Cervix Cancer Stages IIb-IVa

Objectives: Locally advanced cervix cancer represents a therapeutic challenge with a delicate balance between effect and toxicity. Consequently, there is an obvious need for new prognostic parameters with a perspective of a more individualized treatment. The aim of the present study was to evaluate the possible prognostic importance of epidermal growth factor receptor and cyclooxygenase-2 expression in locally advanced cervix cancer. Methods: The study included 91 patients with cervix cancer, FIGO stages IIb-IVa, who were treated with curative intent according to the Nordic Cervix Cancer protocol (NOCECA). The median observation time was 7 years. Epidermal growth factor receptor and cyclooxygenase-2 expression was evaluated by immunohistochemistry using commercially available antibodies. The tumor marker expression was evaluated according to a semi-quantitative scoring system with a positive score when more than 10% of the tumor cells were moderately or strongly stained. Results: Epidermal growth factor receptor and cyclooxygenase-2 over-expression was found in 22% and 18% of the patients, respectively. The survival differed according to epidermal growth factor receptor and cyclooxygenase-2 over-expression as calculated by Kaplan-Meier plots and log-rank test (p = 0.0002 and p = 0.0084 respectively). A multivariate Cox Regression analysis identified each tumor marker as an independent prognostic factor. Conclusion: The results clearly indicate that epidermal growth factor receptor and cyclooxygenase-2 hold important prognostic information, markedly appearing with a long-term observation. We found that both parameters were independent prognostic factors, and to further clarify this matter our retrospective analysis should be confirmed in a prospective study with more patients.