CDX2 expression is increased in gastric cancers with less invasiveness and intestinal mucin phenotype

CDX2 is an intestinal transcription factor that might be involved in the regulation of proliferation and differentiation of intestinal epithelial cells. It is well known that both gastric and intestinal phenotypic cell markers are expressed in gastric cancers. The aims of this study were to analyze the CDX2 expression and its relationship with the patients' clinicopathological characteristics and the mucin phenotypes by performing immunohistochemistry.

A total of 259 gastric cancer cases (122 early and 137 advanced cancers) were evaluated histologically and phenotypically. CDX2 expression was assessed by immunohistochemistry.

Increased CDX2 expression correlated with a higher proportion of intestinal-type cancers of Lauren and early gastric cancers (p<0.001 and p<0.001, respectively) and a lower proportion of perineural invasion and lymph node metastasis (p<0.001 and p=0.003, respectively). Increased expressions of intestinal mucin (MUC-2, CD10) and decreased gastric mucin (MUC5AC) were associated with an increased CDX2 expression (p<0.001, p=0.045 and p=0.004, respectively). MUC6 expression was not associated with CDX2 expression. There was a significantly increased CDX2 expression in the intestinal phenotype compared with the other phenotypes (p<0.001).

These results suggest that CDX2 might be a useful marker in predicting the clinical outcome for patients with gastric cancers.