Association of CDX2 expression and overall survival and clinicopathologic disease manifestations in patients with gastric cancer in Northwest of Iran

Abstract

Introduction: In the northwest of Iran, gastric cancer is the first and third common form of malignancy in men and women, respectively. Homeobox protein CDX2, was proposed as a prognostic biomarker in gastric cancer. Objectives: This study aimed to assess the association of CDX2 expression overall survival as well as clinicopathologic variables in patients with gastric cancer. Materials and Methods: CDX2 expression was examined by the immunohistochemistry method in the formalin-fixed paraffin-embedded surgical specimens of gastric cancer. The association between CDX2 expression and overall survival, stage of the disease, metastasis status, pathology type of the tumor, and serum levels of tumor markers serum levels of tumor markers carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), cancer antigen 19-9 (CA 19-9) was then evaluated. Results: Ninety-two patients with primary gastric cancer were recruited. CDX2 expression was positive in 72 (78%) of the subjects. Overall survival was not significantly different between two groups of patients (CDX2 positive versus negative). However, the risk of death was 21% lower in CDX2 positive patients, after adjusting for age and gender (P = 0.565). Disease stage and metastasis rate were significantly lower in CDX2 positive patients (P = 0.027, and P = 0.021, respectively). Additionally, 71% of the CDX2 positive subjects had intestinal pathology type of the disease (P = 0.025). Accordingly, a significant lower level of CA19-9 was found in CDX2 positive patients as well (P = 0.002). Conclusion: There was not any significant association between CDX2 expression and overall survival in patients with gastric cancer, although the risk of death was lower in CDX2 positive subjects. However, there was a less invasive pattern of gastric carcinoma in this group of patients.

CDX2 and Ki-67 Expression in Gastric Carcinoma and Its Association with Clinocopathological Parameters

“…Differentiated adenocarcinomas are characterized by higher CDX2 expression than undifferentiated tumors with stronger reactivity in intestinal phenotypes. Some of the latest studies have shown inverse relation between CDX2 expression and depth of invasion and lymphnode metastasis [1]. There is a close correlation between the degree of tumor differentiation and the Ki-67 score (p<0.001) [5].…”

“…Stomach cancer incidence rates are much lower in India than elsewhere, but the stomach remains one of the 10 leading sites of cancer in both sexes in most of the metropolitan registries [9]. Gastric carcinoma constitutes the 4 th most common malignancy worldwide with it being 2 nd and 4 th most common reason of malignancy associated death in men and women respectively [1]. Early detection plays a pivotal role in prognosis.…”

“…Gastric cancer patients with CDX2 positive expression had a less invasive pattern of gastric carcinoma and better outcomes. Patient with CDX2 positive expression showed a higher survival rate than CDX2 negative expression (P=0.038), therefore useful in predicting prognosis of gastric carcinomas [1].…”

“…Gastric cancer is the fourth most common malignancy throughout the world after lung, breast and colorectal neoplasms, and the second and fourth reason of malignancy associated death in men and women, respectively [1]. In India gastric cancer remains 5 th most common among males and 7 th most common cancer among females [2].…”

“…Ki-67 is an antigen that corresponds to nuclear nonhistone protein expressed by cells in proliferative phases G1, G2, M and S [1]. Ki-67 is a good marker to detect cell proliferative fraction.…”