Abstract
BackgroundCDX2 is a caudal-homeobox gene and its expression is abnormal in numerous tumour cell types. Nevertheless, its prognostic value for solid tumours requires further investigation. Hence, we conducted a meta-analysis to determine the significance of CDX2 as a prognostic biomarker in solid malignancies systematically.Materials and MethodsWe performed a systematic literature search in PUBMED and EMBASE up to May 2017. Retrospective studies comparing the prognostic value of different CDX2 levels in human malignancies were included. Data extractions and methodological assessments were performed separately by two investigators using a standard procedure. The statistical procedures were performed using Review Manager 5.3 and STATA/MP 14.0.ResultsA total of 26 retrospective studies met the inclusion criteria and comprised 5008 participants. Patients with CDX2 overexpression had significantly better 3-year, 5-year, 10-year and disease-free survival outcomes in solid malignancies, regardless of the cancer type, mean age, and source region. Nevertheless, there was no significant difference in the patients from Europe. The expression level of CDX2 was not statistically associated with cancer relapse. Moreover, our analysis showed that CDX2 overexpression is correlated to better responses to chemotherapy in patients with TNM IV stage cancers. The stability of the pooled outcomes was verified by sensitivity analysis. The funnel plots, Egger’s test and Begg’s test jointly confirmed that there was no publication bias.ConclusionsOverexpression of CDX2 is a reliable biomarker of a better prognosis in solid malignancies.
Highlights
Over the past decade, steady improvements in the overall survival (OS) and disease-free survival (DFS) outcomes have been observed in cancer patients, depending on the availability of new adjuvant treatment regimens
Overexpression of CDX2 is a reliable biomarker of a better prognosis in solid malignancies
Most of the 26 studies were carried out in Asia (n = 14) and Europe (n = 7), and the remaining five were performed in the USA; these studies mainly focused on colorectal cancers (n = 9) and gastric cancers (n = 8)
Summary
Steady improvements in the overall survival (OS) and disease-free survival (DFS) outcomes have been observed in cancer patients, depending on the availability of new adjuvant treatment regimens. No reliable biomarker exists that enables stratification of patients with high-risk diseases for appropriate therapy. CDX2 is a caudal-homeobox gene which is mostly expressed in intestinal epithelial cells. Considerable studies have confirmed that CDX2 is expressed in normal intestinal epithelial cells and in different cancer cell types and functions as a tumour suppressor [4, 5]. Various clinical studies suggest that CDX2 expression is often lost in cancers with high tumour grade and advanced tumour stage [6, 7]. CDX2 is a caudal-homeobox gene and its expression is abnormal in numerous tumour cell types. We conducted a meta-analysis to determine the significance of CDX2 as a prognostic biomarker in solid malignancies systematically
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