COX-2 Expression and Its Prognostic Implications in Uterine Leiomyosarcoma: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.19166/med.v14i2.9547Keywords:
Cyclooxygenase-2, Epithelial-mesenchymal components, Prognostic biomarker, Uterine leiomyosarcomaAbstract
Background : Uterine leiomyosarcoma (ULMS) is a rare, aggressive malignancy with high recurrence and poor survival, necessitating prognostic biomarkers and therapeutic targets. Cyclooxygenase-2 (COX-2), implicated in tumorigenesis and angiogenesis, remains understudied in ULMS. This systematic review and meta-analysis assessed COX-2’s prognostic role in ULMS.
Methods : Following PRISMA guidelines, six studies (n=185) were retrieved from PubMed, EMBASE, and Scopus (2001–2024). Inclusion criteria required ULMS cohorts with COX-2 expression data and survival outcomes. Risk of bias was assessed using QUADAS-2, and evidence certainty via GRADE. A random-effects meta-analysis calculated pooled effect estimates with 95% confidence intervals (CIs), while heterogeneity was evaluated using I² statistics.
Result : COX-2 expression correlated moderately with epithelial components (pooled effect: 0.51, 95% CI: 0.26–0.77) and weakly with mesenchymal components (0.26, 95% CI: 0.06–0.45). High heterogeneity (I² = 89.5% and 82.2%) reflected differences in study design, tumor subtypes, and COX-2 measurement thresholds. QUADAS-2 indicated a low risk of bias, and GRADE confirmed high evidence certainty. Stronger epithelial correlations were observed in Asian cohorts, highlighting geographic variability.
Conclusions: COX-2 plays a more significant role in epithelial-driven ULMS carcinogenesis. Despite heterogeneity, robust methodologies support these findings. Future studies should standardize COX-2 assessment, expand cohort sizes, and integrate multi-omics approaches to refine prognostic and therapeutic applications.
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Copyright (c) 2025 Levita Dyah Kartika Suherman, Kenny Sungkarto, Devanti Octavia Ellyamurti, Tiara Namora Tarigan, Puspa Negara, Teddy Tjahyanto, Jeremiah Hilkiah Wijaya
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