Aim: The objective of this study was to
determine the association between CDX2 and clinicopathological features of
colorectal adenocarcinoma in Ugandan patients.
Introduction: Colorectal
cancer (CRC) is one of the major cancer types worldwide. Although the burden of
CRC is highest in developed countries, the Kampala Cancer Registry in Uganda,
reports a steady rise in the incidence of early-onset CRC. Molecular markers
such as CDX2 represent a bowel-specific tumour suppressor which inhibits the
dissemination and progression of colorectal cancer. Recent advances in the
field of cancer biology have introduced novel biomarkers such as CDX2 that hold
promise in guiding personalized therapeutic decisions and have revolutionised
prognostication. In developed high-income countries, the reduced expression of
CDX2 identifies a sub-group of patients linked to a poor outcome.
Methodology: During
the period 2008 to 2021, immunohistochemistry was carried out on 55 patients’
paraffin-embedded tissue blocks of CRC. CDX2 expression was detected using the
indirect immunoperoxidase method which uses monoclonal antibody CDX2, DAKO
Agilent USA, and Clone DAK-CDX2. The grade, LVI status and histopathological
subtypes of CRC were evaluated using the haematoxylin and eosin stain. The
demographic data, topography and stage of the tumours were obtained from the clinical
patients’ files and the Kampala Cancer Registry.
Results: Out of 55 CRC participants that
were studied, the mean age (SD) was 52.4 (15.8) years and the loss of CDX2
expression was 18.9% overall. Lack of CDX2 expression was significantly
associated with lymphovascular invasion (LVI) (p=0.005). There were 55.6% that
presented with poorly-differentiated adenocarcinoma compared to 22.2%
presenting with well-differentiated adenocarcinoma in those that exhibited a
lack of CDX2 expression, however, this was not statistically significant
(p=0.126). In those exhibiting a lack of CDX2 expression, there were 40% of
participants presented with stage IV disease compared to 20% of CRC
participants with stage I disease (p=0.329). There was a negative correlation
between the CRC grade and CDX2 expression (r=-0.0235) which did not reach
statistical significance (p=0.8729). The findings in the present study in
Ugandan patients, in keeping with previous studies in the West found that loss
of CDX2 expression was associated with poor prognostic markers such as
lymphovascular invasion. These findings from colorectal cancer patients in
Uganda are testimony to the role of loss of CDX2 as a poor prognostic factor in
colorectal adenocarcinoma.
Conclusions: Loss
of CDX2 expression is associated with poor prognostic markers such as the
presence of lymphovascular invasion in Ugandan patients. Loss of CDX2
expression is more frequently seen in advanced-stage colorectal cancer (CRC)
because it is linked to a biologically aggressive tumor. More research in
Uganda is required to determine how chemotherapy affects CDX2-negative tumors
and how this relates to survival.
Author(s)
Details
Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka,
Uganda, Department of Surgery, Faculty of Health Sciences, Equator University
for Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of
Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and
Department of Pathology, School of Biomedical Sciences, College of Health
Sciences, Makerere University, Kampala, Uganda.
Julius Kiwanuka
Department of Epidemiology and Biostatistics, School of Public
Health, College of Health Sciences, Makerere
University, Kampala, Uganda.
Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of
Health Sciences, Makerere University,
Kampala, Uganda.
Michael Odida
Department of Pathology, Faculty of Medicine, Gulu University,
Gulu, Uganda.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v2/1619
No comments:
Post a Comment