TORONTO—Patients with muscle-invasive bladder cancer whose tumors express cyclooxygenase-2 (COX-2) appear to have improved disease-specific survival.

Anis Aziz, MD, senior urology resident at Laval University in Quebec City, and colleagues reviewed data from 273 patients with muscle-invasive bladder cancer treated with cystectomy between 1983 and 2002. The team analyzed the relationship between of a number of patient characteristics and whether they survived.

Elevated COX-2 expression was associated with a 37% increased probability of disease-specific survival, the investigators reported. COX-2 expression was not influenced by tumor stage or grade or by nodal status.

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“This leaves us with the questions of whether COX-2 expression is a good prognostic factor of survival in muscle-invasive bladder tumors, or whether patients who express COX-2 are better responders to nonsteroidal anti-inflammatory drugs and have a better survival,” Dr. Aziz said.

Previously, a large case-control study demonstrated that bladder cancer was 19% less likely to develop in regular users of nonsteroidal anti-inflammatory drugs (Br J Cancer. 2000;827:1364-1369).

Dr. Aziz’s group also found that adjuvant or neoadjuvant chemotherapy was associated with a 44% increased probability of disease-specific survival, whereas age 70 years and older and lymph node involvement decreased disease-specific survival.

Findings were presented here at the Canadian Urological Association (CUA) Annual Meeting.

CUA President Laurence Klotz, MD, commented that these findings are provocative and need to be corroborated by further research. “It’s kind of counterintuitive,” Dr. Klotz said. “You wouldn’t expect a marker of angiogenesis to be a marker of a good prognosis.”