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ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 8  |  Page : 288-290

Cyclooxygenase-2 expression and association with skin cancer: A meta-analysis based on Chinese patients


1 Department of Dermatology, The Sixth Affiliated Hospital of Wenzhou Medical University, People's Hospital, Lishui, China
2 Department of Thyroid and Breast Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, People's Hospital, Lishui, China

Date of Web Publication22-Feb-2017

Correspondence Address:
Shi Yong
Department of Thyroid and Breast Surgery, The Sixth Affiliated Hospital of Wenzhou Medical University, People's Hospital, Lishui 323000
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.200762

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 > Abstract 

Objective: The purpose of this meta-analysis was to evaluate the association between cyclooxygenase-2 (Cox-2) expression and skin cancer.
Materials and Methods: We searched the databases of PubMed, CNKI, and WANFANG to find the case–control studies associated with Cox-2 expression and skin cancer. The association between Cox-2 expression and skin cancer was demonstrated by odds ratio (OR) and its 95% confidence interval (95% CI). The publication bias was evaluated by funnel plot and Egger's line regression test. All the statistical analyses were done by Stata10.0 software (Stata Corporation, College Station, TX, USA).
Results: Ten studies were included in this meta-analysis. Without significant statistical heterogeneity, the data were pooled by fixed-effect model. Ten case–control studies were included in this meta-analysis. The combined results showed a close correlation between Cox-2 expression and skin cancer (OR = 25.00, 95% CI: 13.40–46.64, P < 0.05) with fixed-effect model. Subgroup analysis also indicated that Cox-2 expression was significantly correlated with skin cancer with the pathology type of squamous cell carcinoma (OR = 31.95, 95% CI: 15.08–67.72, P < 0.05) and basal cell carcinoma (OR = 14.69, 95% CI: 4.80–44.94, P < 0.05). Funnel plot and Egger's line regression test indicated no publication bias.
Conclusion: According to the present published data, Cox-2 expression was closely correlated to skin cancer.

Keywords: Cyclooxygenase-2, meta-analysis, skin cancer


How to cite this article:
Shujiao L, Lilin H, Yong S. Cyclooxygenase-2 expression and association with skin cancer: A meta-analysis based on Chinese patients. J Can Res Ther 2016;12:288-90

How to cite this URL:
Shujiao L, Lilin H, Yong S. Cyclooxygenase-2 expression and association with skin cancer: A meta-analysis based on Chinese patients. J Can Res Ther [serial online] 2016 [cited 2017 Apr 25];12:288-90. Available from: http://www.cancerjournal.net/text.asp?2016/12/8/288/200762


 > Introduction Top


Skin cancers are cancers that arise from the skin with three main types: basal cell skin cancer (BCC), squamous cell skin cancer (SCC), and malignant melanoma.[1],[2] BCC and SCC are the two major types of skin cancer accounting for 90% of the skin cancers.[2],[3] BCC grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or results in death. However, SCC is more likely to spread. Malignant melanomas are aggressive and usually cause metastatic disease.

Cyclooxygenase (Cox), also known as prostaglandin-endoperoxide synthase (PTGS), is an enzyme that is responsible for the formation of prostanoids, including thromboxane and prostaglandins such as prostacyclin. Cox-2 is one of the PTGS families. Several published studies have proven that Cox-2 expression was in association with skin cancer. In this study, we further evaluated the association between Cox-2 expression and skin cancer by meta-analysis method.


 > Materials and Methods Top


We searched the databases of PubMed, CNKI, and WANFANG to find the case–control studies associated with Cox-2 expression and skin cancer. The electronic searching words were skin cancer, skin carcinoma, skin squamous cell carcinoma, skin basal cell carcinoma, cyclooxygenase, cyclooxgenase-2, cyclooxygenase, cyclo-oxygenase-2 Cox2. The studies in the inclusion criteria were case–control studies; skin cancers were pathology confirmed with SCC or BCC; Chinese patients and controls; the exclusion criteria were case report or review study type; duplicated published data; and skin cancer with the pathology type of malignant melanoma. The first author name, journal of paper published, year of publication, and Cox-2 expression frequency in case and control groups were extracted by two reviewers.

Statistical analysis

We used Stata10.0 statistical software (Stata Corporation, College Station, TX, USA) to conduct the statistical analysis. The association between Cox-2 expression and skin cancer was expressed by odds ratio (OR) and 95% confidence interval (95% CI). The statistical heterogeneity was evaluated by Chi-square test. The publication bias was evaluated by funnel plot and Egger's line regression test.


 > Results Top


Features of the ten studies

The general features of the included case–control studies were shown in [Table 1]. For the included eight studies,[4],[5],[6],[7],[8],[9],[10],[11],[12] nine were published in Chinese and one in English. The sample size ranged from 28 to 48.
Table 1: The general features of the included ten studies

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Meta-analysis

The combined results showed a close correlation between Cox-2 expression and skin cancer (OR = 25.00, 95% CI: 13.40-–46.64, P < 0.05) with fixed-effect model. Subgroup analysis also indicated that Cox-2 expression was significantly correlated with skin cancer with the pathology type of SCC (OR = 31.95, 95% CI: 15.08–67.72, P < 0.05) and BCC (OR = 14.69, 95% CI: 4.80–44.94, P < 0.05) [Figure 1].
Figure 1: Forest plot for the evaluation of cyclooxygenase-2 expression and skin cancer

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Publication bias

Funnel plot [Figure 2] and Egger's line regression test (t = 1.75, P > 0.05) indicated no publication bias.
Figure 2: Funnel plot for the evaluation of publication bias

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 > Discussion Top


In our present study, we searched the related databases of PubMed, CNKI, and WANFANG. According to the inclusion and exclusion criteria, we finally included 10 studies with 518 patients with skin cancer and 195 healthy controls. We first tested the publication bias by Chi-square test and found no significant heterogeneity across the included studies. Therefore, the data were pooled by fixed-effect model. The combined results showed a significant close correlation between Cox-2 expression and skin cancer (OR = 25.00, 95% CI: 13.40–46.64, P < 0.05) with fixed-effect model. Subgroup analysis also indicated that Cox-2 expression was significantly correlated with skin cancer with the pathology type of SCC (OR = 31.95, 95% CI: 15.08–67.72, P < 0.05) and BCC (OR = 14.69, 95% CI: 4.80–44.94, P < 0.05). These results showed that Cox-2 positive expression rate in patients with skin cancer was significantly higher than that of healthy controls. This means that Cox-2 may play an important role in skin cancer not only for SCC but also for BCC. However, the molecular mechanism of Cox-2 and skin cancer risk is not known.[13] Hence, much attention should be paid for molecular mechanism of Cox-2 and skin cancer risk which can provide us the exact effects of Cox-2 in skin cancer development.[14],[15] Funnel plot and Egger's line regression test were used for publication bias evaluation. The funnel plot was left and right symmetric indicating no publication bias. Moreover, the Egger's line regression test also demonstrated no publication bias. Hence, according to the present published data, Cox-2 expression was closely correlated with skin cancer. However, several limitations exist in our present meta-analysis. First, the sample size of each included study was small ranging from 28 to 48. Second, Cox-2 expression assay is not mentioned in most of the included studies. Third, the general methodology quality of studies was poor. Hence, well-designed large sample case–control or cohort studies are needed for further evaluation of the correlation between Cox-2 expression and skin cancer which can provide strong evidence.

Acknowledgments

This work was funded by a grant from the Medical Science and Technology Planning Project of Zhejiang province, China (Grant No. 2012KYA193, 2013KYB299), Science and Technology Planning Project of Lishui, Zhejiang province, China (Grant No. 2010JYZB24, 20110416, 2014RC11, 2012JYZB71).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Jouary T. What's new in skin cancers? Ann Dermatol Venereol 2014;141 Suppl 4:S630-42.  Back to cited text no. 1
    
2.
Lanoy E. Epidemiology, risk factor and screening for melanoma and other skin cancer. Rev Prat 2014;64:31-6.  Back to cited text no. 2
    
3.
Bulliard JL, Panizzon RG, Levi F. Epidemiology of epithelial skin cancers. Rev Med Suisse 2009;5:882, 884-8.  Back to cited text no. 3
    
4.
Hong Z, Shiguo W, Yadan G. COX-2 and HIF-1α expression in skin cancer and their association with angiogenesis. China Mod Doct 2013;22:35-7.  Back to cited text no. 4
    
5.
Jinqing Z, Hong L, Shanshan W, Yinghua S, Yanli H. Survivin and COX-2 expression in squamous cell skin cancer and their clinical significance. Chin J Dermato Venereol 2010;9:801-3.  Back to cited text no. 5
    
6.
Meng H, Zhao F, Li T, Hongying C, Liuqing C, Weizhen W. Survivin ad COX-2 expression in squamous cell skin cancer and basal cell skin carcinoma. Chin J Dermato Venereol 2010;9:804-6.  Back to cited text no. 6
    
7.
Shuqin Z, Xin W. COX-2 expression in non-neoplastic epithelial disorders and vulvar squamous cell carcinoma. China J Lepr Skin Dis 2009;8:579-81.  Back to cited text no. 7
    
8.
Li Z, Linpan L. COX-2 and HIF-1α expression in skin cancer and its association with microvessel density. J Zhengzhou Univ (Med Sci) 2008;43:210-2.  Back to cited text no. 8
    
9.
Yueping M, Zhaohui D, Fanqin Z, Baozhu L. COX-2 and VEGF expression in skin carcinoma. J Fourth Mil Med Univ 2006;18:1720-2.  Back to cited text no. 9
    
10.
Ning Z, Chao G, Jiuhong L. COX-2 and VEGF mRNA expression in squamous cell skin carcinoma. Chin J Dermatol 2006;9:536-8.  Back to cited text no. 10
    
11.
Zeng Weihui TS, Lei Xiaobing ZJ, Baoshan S. COX-2 expression in skin carcinoma and its clinical significance. Chin J Dermato Venereol 2004;9:16-8.  Back to cited text no. 11
    
12.
Wu Y, Liu H, Li J. Expression of p63 and cyclooxygenase-2 and their correlation in skin tumors. J Huazhong Univ Sci Technol Med Sci 2007;27:206-8.  Back to cited text no. 12
    
13.
Brecher AR. The role of cyclooxygenase-2 in the pathogenesis of skin cancer. J Drugs Dermatol 2002;1:44-7.  Back to cited text no. 13
    
14.
Cocoş R, Schipor S, Nicolae I, Thomescu C, Raicu F. Role of COX-2 activity and CRP levels in patients with non-melanoma skin cancer. -765G>C PTGS2 polymorphism and NMSC risk. Arch Dermatol Res 2012;304:335-42.  Back to cited text no. 14
    
15.
O'Grady A, O'Kelly P, Murphy GM, Leader M, Kay E. COX-2 expression correlates with microvessel density in non-melanoma skin cancer from renal transplant recipients and immunocompetent individuals. Hum Pathol 2004;35:1549-55.  Back to cited text no. 15
    


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