Pan Jun, Jiao Xiaodong, Yang Zhihui, Li Jie, Chen Yitian, Chu Xiaoyuan
Altern Ther Health Med. 2024 Dec;30(12):388-392.
Caudal-type homologous transcription factor 2 (CDX2) has been shown to be associated with prognosis in colorectal cancer, with those with high expression having a good prognosis and those with low expression having a poor prognosis. As duodenal and colorectal cancers are similar in histological origin, we suspect that CDX2 expression in duodenal cancer may also be related to prognosis. Therefore, the aim of this study was to investigate the expression of CDX2 in duodenal cancer and its relationship with prognosis.
We collected the clinical data and pathological sections of 61 patients diagnosed with duodenal cancer by histopathology or cytology at Shanghai Changhai Hospital, Naval Medical University, from November 2011 to December 2022. CDX2 expressionin in duodenal cancer was detected by immunohistochemical analysis (streptavidin-peroxidasemethod, SP). Survival analysis was conducted using the Kaplan-Meier method and the Log-rank test. Multivariate analysis was performed using the Cox regression analysis.
The positive rate of CDX2 in duodenal carcinoma was 78.7% (48/61). The positive rate of CDX2 expression in patients with stage I/II was higher than that in patients with stage III/IV (P < .05), and there was no correlation between CDX2 expression and gender, age, degree of differentiation, CEA and anemia (P > .05). Univariate analysis by Kaplan-Meier and Log-rank test showed that the expression of CDX2, degree of differentiation, TNM staging and CEA were associated with the prognosis of CDX2 in the negative and positive for the OS 21.6 months and 49.8 months, respectively (P = .015). The median OS of poorly differentiated patients and moderately/well-differentiated patients were 13 months and 82.5 months, respectively (P < .001). The median OS for Stage I/II and Stage III/IV patients was 72.3 and 13 months, respectively (P < .001). The median OS of CEA < 5 ug/L and ≥5 ug/L were 49.8 months and 9.4 months, respectively (P = .002). Age, gender and whether anemia were not associated with prognosis (P > .05). Multivariate analysis by Cox regression analysis showed that the expression of CDX2 (RR=2.697, 95%CI: 1.191-6.106, P = .017) was an independent prognostic factor of duodenal carcinoma. The results suggest that the expression of CDX2 in duodenal cancer is closely related to the prognosis. Those with positive expression have a better prognosis and those with negative expression have a worse prognosis.
CDX2 serves as an autonomous prognostic determinant in individuals diagnosed with duodenal cancer. Notably, patients exhibiting positive CDX2 expression demonstrate a considerably improved prognosis compared to those with negative CDX2 expression. CDX2 may play an important role as an tumor suppressor gene in the development of duodenal cancer. CDX2 can be used as an important factor for evaluating the prognosis of patients with duodenal cancer, and it has the potential to be a target for duodenal cancer therapy.
尾型同源转录因子2（CDX2）已被证明与结直肠癌的预后相关，高表达者预后良好，低表达者预后较差。由于十二指肠癌和结直肠癌在组织学起源上相似，我们推测十二指肠癌中CDX2的表达可能也与预后有关。因此，本研究旨在探讨CDX2在十二指肠癌中的表达及其与预后的关系。
我们收集了2011年11月至2022年12月在海军军医大学附属上海长海医院经组织病理学或细胞学确诊为十二指肠癌的61例患者的临床资料和病理切片。采用免疫组织化学分析（链霉亲和素-过氧化物酶法，SP）检测十二指肠癌中CDX2的表达。采用Kaplan-Meier法和Log-rank检验进行生存分析。采用Cox回归分析进行多因素分析。
十二指肠癌中CDX2的阳性率为78.7%（48/61）。Ⅰ/Ⅱ期患者CDX2表达阳性率高于Ⅲ/Ⅳ期患者（P<0.05），CDX2表达与性别、年龄、分化程度、癌胚抗原（CEA）及贫血无关（P>0.05）。Kaplan-Meier法和Log-rank检验的单因素分析显示，CDX2表达、分化程度、TNM分期及CEA与十二指肠癌患者的预后相关，CDX2阴性和阳性患者的总生存期（OS）分别为21.6个月和49.8个月（P=0.015）。低分化患者和中/高分化患者的中位OS分别为13个月和82.5个月（P<0.001）。Ⅰ/Ⅱ期和Ⅲ/Ⅳ期患者的中位OS分别为72.3个月和13个月（P<0.001）。CEA<5μg/L和≥5μg/L患者的中位OS分别为49.8个月和9.4个月（P=0.002）。年龄、性别及是否贫血与预后无关（P>0.05）。Cox回归分析的多因素分析显示，CDX2表达（RR=2.697，95%CI：1.191-6.106，P=0.017）是十二指肠癌的独立预后因素。结果表明，十二指肠癌中CDX2的表达与预后密切相关。阳性表达者预后较好，阴性表达者预后较差。
CDX2是十二指肠癌患者的一个独立预后决定因素。值得注意的是，与CDX2表达阴性的患者相比，CDX2表达阳性的患者预后有显著改善。CDX2可能作为一种肿瘤抑制基因在十二指肠癌的发生发展中起重要作用。CDX2可作为评估十二指肠癌患者预后的重要因素，并有潜力成为十二指肠癌治疗的靶点。
