Clinicopathological Correlation Of Cdx2 Expression With Prognostic Parameters In Colorectal Adenocarcinomas:A Retrospective Study

Abstract

Background: Colorectal cancer (CRC) requires robust, affordable biomarkers for risk stratification. CDX2, an intestinal differentiation transcription factor, is frequently expressed in CRC, but its clinicopathological correlates in our setting remain underreported. 

Methods: We conducted a cross-sectional analytical study of 42 histologically confirmed colorectal adenocarcinomas resected at a tertiary centre. CDX2 immunohistochemistry was performed on FFPE sections, and tumors were categorized as CDX2-positive or -negative (with intensity graded). Associations between CDX2 status and clinicopathological parameters (age, sex, site, size, grade, depth of invasion, nodal status, tumor budding, lymphovascular invasion [LVI], perineural invasion [PNI], peritumoral lymphoid aggregates, and AJCC stage) were tested using chi-square (p<0.05). 

Results: CDX2 nuclear expression was present in 36/42 cases (85.7%), absent in 6/42 (14.3%). Loss of CDX2 was significantly associated with age >60 years (p=0.04) and male sex (p=0.03). Proximal (right-sided) tumors showed more frequent CDX2 loss than left-sided/rectal cancers (p=0.02). Adverse pathological features correlated with CDX2 loss, including larger size (≥5 cm; p=0.05), poor differentiation (p=0.01), greater depth of invasion (p=0.001), tumor budding (p=0.01), LVI (p=0.03), and borderline PNI (p=0.05). Stage distribution differed by CDX2 (p=0.04), and peritumoral lymphoid aggregates were more common in CDX2-positive tumors (p=0.02). 

Conclusion: Most CRCs retained CDX2 expression; however, CDX2-negative tumors comprised a distinct subset enriched for high-risk features. Routine CDX2 assessment may aid prognostic stratification—particularly in early-stage disease—while acknowledging the need for outcome-linked, multicentre validation.