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World J Gastroenterol. 2012 Jul 7;18(25):3296-302. doi: 10.3748/wjg.v18.i25.3296.

Expression and significance of homeodomain protein Cdx2 in gastric carcinoma and precancerous lesions.

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  • 1Department of Pathology, Basic Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China.



To investigate the expression and significance of caudal-related homeobox transcription factor (Cdx2) in gastric carcinoma (GC) and precancerous lesions.


The expression of Cdx2 in GC, precancerous lesions and normal gastric mucosa were detected using immunohistochemical method. Hematoxylin and eosin staining, alcian blue/periodic acid-schiff and high iron diamine/alcian blue staining were used to classify intestinal metaplasia (IM) and GC.


Cdx2 was not detected in normal gastric mucosa. Cdx2 expression was detected in 87.1% (101/116) of IM, 50% (36/72) of dysplasia and 48.2% (41/85) of GC. The Cdx2-expressing cells in IM were more prevalent than in dysplasia and carcinoma (P < 0.05). There was no relationship between Cdx2 expression and the classification of IM or the degree of dysplasia. Expression of Cdx2 was significantly higher in intestinal-type carcinoma than in diffuse and mixed-type carcinoma (P < 0.05). Positive expression of Cdx2 was mainly found in moderately to well differentiated GC. There was a negative association between nuclear Cdx2 expression and lymph node metastasis and tumor, nodes, metastasis stage of GC (P < 0.05). The patients with Cdx2-positive expression showed a higher survival rate than those with Cdx2-negative expression (P = 0.038). Multivariate analysis revealed that the expression of Cdx2 and lymph node metastasis were independent prognostic indicators of GC (P < 0.05).


Cdx2 may be closely related to IM and the intestinal-type GC and implicate better biological behavior and outcome. Cdx2 is useful for predicting the prognosis of GC.


Caudal-related homeobox transcription factor; Dysplasia; Immunohistochemistry; Intestinal metaplasia; Stomach neoplasm

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