Cyclooxygenase-2 (COX-2) and hypoxia-induced factor 1α (HIF1α) expression in colorectal carcinoma and its correlation with other clinicopathological parameters.

Abstract

Background: Colorectal cancer is identified as the third-most prevalent cancer globally and the second leading cause of cancer mortality.

Methods: This study investigated the immunohistochemical expression of Cyclooxygenase-2 and Hypoxia-Induced Factor 1 alpha & correlated their expression with clinicopathological parameters in 100 retrospectively selected cases of colorectal adenocarcinoma from Port Said Governorate, Egypt.

Results: COX-2 was positively expressed in 67% of cases, and HIF-1α was positive in 57%. COX-2 positivity was statistically significantly associated only with lymph node metastasis (p = 0.019). HIF-1α positivity showed significant associations with multiple indicators of aggressive disease, including high tumor grade (p < 0.001), advanced tumor stage (T3-T4, p = 0.047), lymph node metastasis (p < 0.001), and advanced TNM stage (p = 0.006). Crucially, a statistically significant positive correlation was detected between the expression of COX-2 and HIF-1α (p = 0.039).

Conclusion: COX-2 and HIF-1α are often expressed in colorectal carcinoma and are significantly associated with aggressive clinicopathological features, notably lymph node metastasis and advanced tumor stage. The significant co-expression of these two markers supports a biological constructive collaboration, suggesting that their simultaneous presence drives tumors toward a more invasive and metastatic phenotype, predicting a poorer prognosis. Detection of COX-2 and HIF-1α is recommended as an effective index for assessing prognosis and identifying high-risk patients.