Several reports have recently highlighted the biological and clinical role of cyclooxy-genase (COX)-2, the key enzyme in the conversion of arachidonic acid to prostaglandins, in the pathogenesis and natural history of human cancer (43). In particular, COX-2 overexpression is involved in the inhibition of apoptosis, increased metastatic potential and neoangiogenesis, and impairment of host immune responses. Moreover, COX-2 has been associated with parameters of tumor aggressiveness and unfavorable prognosis in several solid tumors including colorectal, breast, ovarian, and cervical cancer. Several reports have shown that high COX-2 expression in tumor cells characterizes cervical cancer patients with poor survival, regardless of the type of primary treatment (44,45). Moreover, COX-2 status could provide additional information to identify patients with cervical cancer with a poor chance of response to neoadjuvant treatment and unfavorable prognosis (46).
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