Hao Chen1#, Bixia Liang1#, Yandong Zhao2#, Jintuan Huang1, Yingming Jiang1, Tuoyang Li1, Yi Liao1, Yan Huang2 and Zuli Yang1*
1Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, China
2Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-sen University, China
#These authors contributed equally to this work
Background: Caudal-type homeobox transcription factor 2 (CDX2) is an important molecule for Gastric Intestinal Metaplasia (GIM). Experiments have shown that ectopic expression of CDX2 in normal gastric tissue induces GIM, which gradually develops into Gastric Adenocarcinoma (GAC).
Objectives: This study aimed to investigate the correlation between CDX2 expression and the prognosis of GAC patients with different clinical features, especially, to indicate whether high CDX2 expression predicts a favorable prognosis in patients with early-stage diffuse type gastric adenocarcinoma.
Methods: A total of 619 gastric tissues from GAC patients were analyzed. Tissue microarrays and immunohistochemistry were used to investigate the expression and prognostic significance of CDX2 in GAC. The associations’ between CDX2 expression, clinicopathological parameters and prognosis were evaluated.
Results: CDX2 expression was higher in early-stage GAC tissues than in other tissues. High CDX2 expression positively correlated with gender (P<0.001), Lauren classification (P=0.024), depth of invasion (P<0.001), TNM stage (P<0.001), tumor site (P=0.037) and perineural invasion (P=0.002). Patients with high CDX2 expression had better overall survival (OS; P=0.033) and disease-free survival (DFS; P=0.031) than patients with lower expression. In T1 GAC, high CDX2 expression was also associated with better OS (P=0.033) and DFS (P=0.020). Multivariate analysis confirmed that high CDX2 expression was an independent prognostic factor of OS and DFS in GAC patients (P<0.05).
Conclusion: High CDX2 expression correlates with better OS and DFS and can serve as an independent prognostic marker in GAC, especially in the early stage.
Gastric adenocarcinoma; CDX2; Immunohistochemistry; Clinical pathology; Prognosis
Chen H, Liang B, Zhao Y, Huang J, Jiang Y, Li T, et al. High CDX2 Expression Predicts a Favorable Prognosis in Patients with Early-Stage Gastric Adenocarcinoma. Clin Oncol. 2021;6:1882..