ArticleFrontiers in oncology2013
Loss of Cdx2 Expression in Primary Tumors and Lymph Node Metastases is Specific for Mismatch Repair-Deficiency in Colorectal Cancer.
Article in Frontiers in oncology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 40 citations in OpenAlex.
- The prognostic impact of CDX2 correlates with the underlying mismatch repair status and BRAF mutational status but not with distant metastasis in colorectal cancer.Virchows Archiv : an international journal of pathology · 2018Trial
- Low CDX2 expression and its clinicopathological associations in colorectal adenocarcinoma: prognostic insights from a retrospective cross-sectional study in Vietnam.Diagnostic pathology · 2025Article
- CDX2 and SATB2 loss are associated with myeloid cell infiltration and poor survival in colorectal cancer.Cancer immunology, immunotherapy : CII · 2025Article
- Evaluation of the Immunohistochemical Scoring System of CDX2 Expression as a Prognostic Biomarker in Colon Cancer.Diagnostics (Basel, Switzerland) · 2024Article
- Biomarkers of lymph node metastasis in colorectal cancer: update.Frontiers in oncology · 2024Review
- Potential predictors for CDX2 expression loss and mismatch repair deficiency in colorectal cancer.Pathology oncology research : POR · 2023Article
- Comprehensive clinicopathologic, molecular, and immunologic characterization of colorectal carcinomas with loss of three intestinal markers, CDX2, SATB2, and KRT20.Virchows Archiv : an international journal of pathology · 2022Article
- CDX2 Protein Expression in Colorectal Cancer and ItsCorrelation with Clinical and Pathological Characteristics, Prognosis, and Survival Rate of Patients.Journal of gastrointestinal cancer · 2020Article
- Combination of CDX2 expression and T stage improves prognostic prediction of colorectal cancer.The Journal of international medical research · 2019Article
- Prognostic impact of CDX2 in stage II colon cancer: results from two nationwide cohorts.British journal of cancer · 2018Article
- CDX2 in colorectal cancer is an independent prognostic factor and regulated by promoter methylation and histone deacetylation in tumors of the serrated pathway.Clinical epigenetics · 2018Article
- Loss of CDX2 gene expression is associated with DNA repair proteins and is a crucial member of the Wnt signaling pathway in liver metastasis of colorectal cancer.Oncology letters · 2018Article
- Prognostic significance of CDX2 immunoexpression in poorly differentiated clusters of colorectal carcinoma.Virchows Archiv : an international journal of pathology · 2017Article
- Targeted CDX2 expression inhibits aggressive phenotypes of colon cancer cells in vitro and in vivo.International journal of oncology · 2017Article
- Epigenetic Biomarkers in Colorectal Cancer.Molecular diagnosis & therapy · 2017Review
- SOX2 expression is associated with a cancer stem cell state and down-regulation of CDX2 in colorectal cancer.BMC cancer · 2016Article
- Loss of CDX2 expression is associated with poor prognosis in colorectal cancer patients.World journal of gastroenterology · 2015Article
- Towards a molecular classification of colorectal cancer.Frontiers in oncology · 2015Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundApproximately 20% of all colorectal cancers are hypothesized to arise from the "serrated pathway" characterized by mutation in BRAF, high-level CpG Island Methylator Phenotype, and microsatellite instability/mismatch repair (MMR)-deficiency. MMR-deficient cancers show frequent losses of Cdx2, a homeodomain transcription factor. Here, we determine the predictive value of Cdx2 expression for MMR-deficiency and investigate changes in expression between primary cancers and matched lymph node metastases.
methodsImmunohistochemistry for Cdx2, Mlh1, Msh2, Msh6, and Pms2 was performed on whole tissue sections from 201 patients with primary colorectal cancer and 59 cases of matched lymph node metastases. Receiver operating characteristic curve analysis and Area under the Curve (AUC) were investigated; association of Cdx2 with clinicopathological features and patient survival was carried out.
resultsLoss of Cdx2 expression was associated with higher tumor grade (p = 0.0002), advanced pT (p = 0.0166), and perineural invasion (p = 0.0228). Cdx2 loss was an unfavorable prognostic factor in univariate (p = 0.0145) and multivariate [p = 0.0427; HR (95% CI): 0.58 (0.34-0.98)] analysis. The accuracy (AUC) for discriminating MMR-proficient and - deficient cancers was 87% [OR (95% CI): 0.96 (0.95-0.98); p < 0.0001]. Specificity and negative predictive value for MMR-deficiency was 99.1 and 96.3%. One hundred and seventy-four patients had MMR-proficient cancers, of which 60 (34.5%) showed Cdx2 loss. Cdx2 loss in metastases was related to MMR-deficiency (p < 0.0001). There was no difference in expression between primary tumors and matched metastases.
conclusionLoss of Cdx2 is a sensitive and specific predictor of MMR-deficiency, but is not limited to these tumors, suggesting that events "upstream" of the development of microsatellite instability may impact Cdx2 expression.
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