{"entity": "publication", "iuid": "b1f69b2ababc4270a0413b5ac74b1669", "timestamp": "2026-08-26T22:48:10.238Z", "links": {"self": {"href": "https://publications-affiliated.scilifelab.se/publication/b1f69b2ababc4270a0413b5ac74b1669.json"}, "display": {"href": "https://publications-affiliated.scilifelab.se/publication/b1f69b2ababc4270a0413b5ac74b1669"}}, "title": "CDX2: A Prognostic Marker in Metastatic Colorectal Cancer Defining a Better BRAF Mutated and a Worse KRAS Mutated Subgroup.", "authors": [{"family": "Aaseb\u00f8", "given": "Kristine", "initials": "K"}, {"family": "Dragomir", "given": "Anca", "initials": "A"}, {"family": "Sundstr\u00f6m", "given": "Magnus", "initials": "M"}, {"family": "Mezheyeuski", "given": "Artur", "initials": "A"}, {"family": "Edqvist", "given": "Per-Henrik", "initials": "PH"}, {"family": "Eide", "given": "Geir Egil", "initials": "GE"}, {"family": "Ponten", "given": "Fredrik", "initials": "F"}, {"family": "Pfeiffer", "given": "Per", "initials": "P"}, {"family": "Glimelius", "given": "Bengt", "initials": "B"}, {"family": "Sorbye", "given": "Halfdan", "initials": "H"}], "type": "journal article", "published": "2020-02-11", "journal": {"title": "Front Oncol", "issn": "2234-943X", "volume": "10", "pages": "8", "issn-l": "2234-943X"}, "abstract": "Background: Survival of metastatic colorectal cancer (mCRC) patients has improved, but mainly for trial patients. New predictive and prognostic biomarkers validated in the general mCRC population are needed. Caudal-type homeobox 2 (CDX2) is an intestine-specific transcription factor with potential prognostic and predictive effect, but the importance in mCRC has not been fully investigated. Methods: Immunohistochemistry analysis of CDX2 was performed in a Scandinavian population-based cohort of mCRC (n = 796). Frequency, clinical and tumor characteristics, response rate, progression-free survival, and overall survival (OS) were estimated. Results: Loss of CDX2 expression was found in 87 (19%) of 452 stained cases, in 53% if BRAF mutated (BRAFmut) and in 9% if KRAS mutated (KRASmut). CDX2 loss was associated with microsatellite instability, BRAFmut, and poor differentiation and inversely associated with KRASmut. Patients with CDX2 loss received less first-line (53 vs. 64%, p = 0.050) and second-line (23 vs. 39%, p = 0.006) chemotherapy and secondary surgery (1 vs. 9%, p = 0.019). Median progression-free survival and OS for patients given first-line combination chemotherapy was 4 and 10 months if CDX2 loss vs. 9 and 24 months if CDX2 expressed (p = 0.001, p < 0.001). Immediate progression on first-line combination chemotherapy was seen in 35% of patients with CDX2 loss vs. 10% if CDX2 expressed (p = 0.003). Median OS in patients with BRAFmut or KRASmut and CDX2 expressed in tumor (both 21 months) was comparable to wild-type patients (27 months). However, if CDX2 loss, median OS was only 8 and 11 months in BRAFmut and KRASmut cases, respectively, and 10 months in double wild-type patients. In multivariate analysis, CDX2 loss (hazard ratio: 1.50, p = 0.027) and BRAFmut (hazard ratio: 1.62, p = 0.012) were independent poor prognostic markers for OS. Conclusion: In a population-based cohort of mCRC patients, CDX2 loss is an independent poor prognostic marker. Expression of CDX2 defines a new subgroup of BRAFmut cases with a much better prognosis. Loss of CDX2 defines a small group of KRASmut cases with a worse prognosis. Patients with CDX2 loss receive less palliative chemotherapy with less benefit and rarely reach secondary surgery.", "doi": "10.3389/fonc.2020.00008", "pmid": "32117703", "labels": [], "xrefs": [{"db": "pmc", "key": "PMC7026487"}], "notes": [], "created": "2026-08-21T13:00:14.524Z", "modified": "2026-08-21T13:00:14.559Z"}