Cyclooxygenase‐2 (COX‐2) as a Potential Prognostic Marker in Oral Squamous Cell Carcinoma: A Systematic Review and Meta‐Analysis

Background and Aims Oral squamous cell carcinoma (OSCC) is the predominant form of head and neck squamous cell carcinoma (HNSCC), accounting for most cancer‐related deaths due to metastasis and recurrence. COX‐2, an inflammatory biomarker encoded by prostaglandin‐endoperoxide synthase 2 (PTGS2) gene, has been shown to play a significant role in the prognosis of OSCC. Herein, we performed this meta‐analysis to evaluate COX‐2 as a potential therapeutic target in OSCC. Methods PubMed, Embase, Web of Science, and Scopus databases were searched from inception to April 2024, to identify studies with Immunohistochemistry (IHC)‐based quantification that measure the clinicopathological features and prognostic significance of COX‐2 in OSCC. The role of COX‐2 expression in OSCC was evaluated by pooled hazard ratios (HRs), odd ratios (ORs) and 95% confidence intervals (CIs). The meta‐analysis was performed using the Review Manager (RevMan) version 5.4.1. Results Ten studies were included in this review. High expression of COX‐2 was significantly associated with poor prognosis, with overall survival and progression‐free survival in patients with OSCC indicated by the pooled HR (HR 1.49, 95% Cl: 1.06–2.10) and (HR: 1.86, 95% CI: 1.21–2.87), respectively. Also, high COX‐2 expression was significantly associated with advanced T stage (T3/T4) and TNM stage (ll/lV), as shown by the pooled OR (OR: 2.91, 95% Cl: 1.52–5.55) and (OR: 2.68, 95% CI: 1.43–5.02), respectively. However, there was no significant association between lymph node metastasis and high expression of COX‐2 (pooled OR: 2.16, 95% Cl: 0.71–6.57). Conclusion In conclusion, the present evidence suggests a role of COX‐2 overexpression as a prognostic biomarker and in targeted therapy of OSCC patients. Further studies on the role of COX‐2 expression might provide a more profound insight into the mechanism of carcinogenesis in OSCC.