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Hum. Reprod. Advance Access published online on June 24, 2005
Human Reproduction, doi:10.1093/humrep/dei160
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
Received December 22, 2005
Revised May 21, 2005
Accepted May 27, 2005

Article

Increased cyclooxygenase-2 expression is associated with better clinical outcome in patients submitted to complete ablation for severe endometriosis

Francesco Fanfani 1, Anna Fagotti 1, Gabriella Ferrandina 2, Giuseppe Bifulco 1, Francesco Legge 2, Domenica Lorusso 1, Luca Minelli 3, and Giovanni Scambia 4*

1 Department of Oncology, Division of Gynaecologic Oncology, Catholic University of Sacred Heart, Campobasso
2 Division of Gynaecologic Oncology, Catholic University of Sacred Heart, Rome
3 Department of Obstetrics and Gynecology, Sacred Heart Hospital, Negrar (VR), Italy
4 Department of Oncology, Division of Gynaecologic Oncology, Catholic University of Sacred Heart, Campobasso; Department of Obstetrics and Gynaecology, Catholic University, L.go A.Gemelli, 8, 00168 Rome, Italy

* To whom correspondence should be addressed.
Giovanni Scambia, E-mail: giovanni.scambia{at}rm.unicatt.it


  Abstract

BACKGROUND: Recent studies have demonstrated the overexpression of cyclooxygenase-2 (COX-2) in endometriosis. The aim of this study was to investigate the correlation between COX-2 expression and the clinical outcome rate in a homogeneous series of patients undergoing fertility-sparing complete laparoscopic ablation for severe endometriosis. METHODS: COX-2 expression was analysed by immunohistochemistry in 103 samples, 71 endometriomas (group 1) and 32 peritoneal implants and or recto-vaginal nodules (group 2) of endometriotic tissue from 85 patients submitted to complete laparoscopic ablation of severe endometriosis. RESULTS: At median follow-up of 54 months, a recurrence rate of 24.7% (n = 21) was observed. Patients with COX-2-positive endometriotic cysts showed a lower relapse rate than COX-2-negative cases (16.7 versus 41.2%; P = 0.036). Patients with COX-2-positive peritoneal implant and or recto-vaginal nodule showed a similar trend. Taking the two groups of patients together, we found a significantly lower relapse rate in COX-2-positive patients in comparison to COX-2-negative patients (16.4 versus 40%; P = 0.0152). Moreover, COX-2-positive patients showed a longer relapse-free survival in comparison to COX-2-negative patients (P = 0.016). CONCLUSIONS: In patients with severe endometriosis who underwent fertility-sparing complete ablation, COX-2 overexpression characterizes a subgroup of patients with lower risk of relapse and longer relapsefree survival.

Keywords: COX-2/endometriosis/relapse.
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