Research Progress of Cyclooxygenase-2 in Colorectal Adenomas

Background: Cyclooxygenase-2 (COX-2) serves as a pivotal molecule bridging inflammation and tumor development, playing a central role in the initiation, progression, and malignant transformation of colorectal adenomas. Methods: This review systematically examines COX-2 expression patterns, molecular regulatory networks, and its potential applications in clinical diagnosis, prognosis assessment, and chemoprevention. Results: Evidence indicates that COX-2 exhibits significantly elevated expression in adenoma tissues (e.g., 54.8% positive rate in polyps vs. 18.5% in adjacent tissue), driving pathological progression through multiple mechanisms including cell proliferation induction, apoptosis inhibition, angiogenesis promotion, and tumor immune microenvironment remodeling. Nonsteroidal anti-inflammatory drugs and selective COX-2 inhibitors have demonstrated clear promise in adenoma chemoprevention (with agents such as celecoxib reducing advanced adenoma recurrence risk by 33%−45%). Conclusions: COX-2 is a critical early-event biomarker and therapeutic target in colorectal adenomas. Targeting the COX-2 pathway represents a viable strategy for prevention, although challenges regarding safety and personalized application remain.