Caudal-type Homeobox Transcription Factor 2 Expression Along the Correa Pathway of Gastric Carcinogenesis: A Cross-sectional Study

Caudal type homeobox transcription factor 2 (CDX2) is a nuclear factor that belongs to the caudal-related family of CDX homeobox genes, which are normally expressed in the intestinal mucosa. When expressed in the stomach, CDX2 signifies metaplastic mucosal changes. This study aimed to determine the expression of CDX2 in biopsies with various lesions along the Correa pathway of gastric carcinogenesis. This study was conducted at the University Teaching Hospital in Lusaka, Zambia. This cross-sectional study utilising archival gastric biopsies and stained them for CDX2 expression using standard immunohistochemical techniques. Data analysis was performed using Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC. A total of 148 samples were analyzed in this study, of which 67 (49%) were from women and 69 (51%) were from men. The median age was 55 years, IQR 45-66. Overall, CDX2 expression was observed in 12 (8%) samples. Aggregated by stage along the Correa pathway, CDX2 positivity was 11% in GIM, 20% in dysplasia, and 23% in gastric cancer. None of the samples with normal gastric mucosa, non-atrophic gastritis, or chronic atrophic gastritis showed CDX2 expression. There was no association between CDX2 expression and age (p=1.0), sex (p=0.09), HIV (p=0.62), biomass smoke exposure (0.14), or Helicobacter pylori infection (p=1.0). No statistically significant difference was observed in CDX2 expression between complete and incomplete intestinal metaplasia. In conclusion, the expression of CDX2 increases with the severity of lesions along the Correa pathway and could potentially be used as a biomarker of gastric carcinogenesis.