Correlational Analysis Between The Prognosis Of Colorectal Carcinoma And The Expression Of CDX2 And COX2

Objective: In our country,colorectal cancer incidence and mortality keep rising trend recently 30 years,and most patients belong to tumor stage III/IV when the tumor has been found.Recently,more and more studies have found that CDX2(caudal-related homeobox transcription factor 2)and COX2(cyclooxygenase 2)involve to participate in the process of formation,invasion and metastasis of colorectal cancer,and through multiple signal transduction pathways CDX2 could regulate transcription and expression of COX2,closely correlating between each other.This experiment by studying the protein expression levels of CDX2 and COX2 in colorectal cancer tissues,explored the correlation between expression of colorectal cancer and the clinical pathological factors,the correlation between the two expression as well as and the correlation between the prognosis of patients with colorectal cancer.It could provides an objective basis for the assessment of colorectal cancer early diagnosis and prognosis.Methods: We randomly selected 44 patients with adenocarcinoma of colorectal carcinoma pathologically confirmed after operation in First Affiliated Hospital of Dalian Medical University from June 2009 to June 2011.All patients with colorectal cancer have received the radical operation,have not been received preoperative radiotherapy and chemotherapy,the clinical and pathological data are integrated.Postoperative follow-up way takes phone call,the start point was the day of surgery,the outcome was death of patients,lost to follow-up,or reach the deadline(June 3,2016).At the end of follow-up,to obtain a complete follow-up data of 40 cases,the follow-up rate was90.9%,15 cases of colorectal cancer patients have died.While we have chose from the operative edge normal tissues which mor than 3cm distanced from tumor as controlgroup.Using immunohistochemical staining method to detect the CDX2 and COX2 protein expression levels of the 44 cases of colorectal adenocarcinoma and its corresponding normal colorectal mucosa tissue adjacent to carcinoma specimens.Usingχ2test and Fisher test to analyze the relationship between the positive rate of CDX2、COX2 and clinical pathological factors.Using Spearman test to analyze the relationship between the expression levels of CDX2 and COX2 in colorectal carcinoma tissue.Using Log-rank to analyze the difference of prognostic indicator(like OS,DFS,5-year survival rate,post-operative survival)between positive and negative expression of CDX2 and COX2.Results:1.There was obvious different degree of CDX2 expression level in colorectal cancer tissues and normal tissue adjacent to carcinoma,the positive expression in colorectal cancer tissues was 65.9%(29/44),while the positive expression in no rmal colorectal mucosa tissues adjacent to carcinoma was 93.2%(41/44),there was significant difference between two groups,χ2=10.057,P=0.003).There was als o different degree of COX2 expression level incolorectalcancer tissues and norma l tissue adjacent to carcinoma,the positive expression incolorectal cancer tissues was 72.7%(32/44),while the positive expression in normal colorectal mucos a tissues adjacent to carcinoma was 25.0%(11/44),there was significant differe nce between two groups,χ2=20.056,P<0.001).2.The expression of CDX2 was NOT correlated with sex,age,tumor stage,invasion and distant metastasis(P>0.05),which is closely correlated to the degree of differentiation,lymph node metastasis,tumor location and 5-year survival rate(P<0.05).The expression of COX2 was NOT correlated with sex,age,tumor sta ge,tumor location,invasion,distant metastasis,the degree of differentiation,lym ph node metastasis and 5-year survival rate(P>0.05).3.The inverse relationship has been shown for CDX2 expression and COX2 expression in colorectal cancer on Spearman rank sum test.(r=-0.339,P=0.024<0.05)4.In the all cases colorectal carcinoma tissue,Middle Overall Survival(mOS)of the positive expression of CDX2 was 62.09 mouths,mOS of the negative case was 39.86 mouths,the former was significantly longer than the latter,χ2=6.844,P=0.009,the difference was statistically significant.Middle Disease-free Survival(mDFS)of the positive expression of CDX2 was 51.65 mouths,mDFS of the negative cases was 26.79 mouths,the former was also significantly longer than the latter,χ2=7.246,P=0.007,the difference was statistically significant.In the all cases colorectal carcinoma tissue,Middle Overall Survival(mOS)of the positive expression of COX2 was54.70 mouths,mOS of the negative case was55.23 mouths,the latter was NOT significantly longer than the former,χ2=0.901,P=0.342,the difference was NOT statistically significant.Middle Disease-free Survival(m DFS)of the positive expression of COX2 was 43.02 mouths,mPFS of the negative cases was 44.86 mouths,the latter was also NOT significantly longer than the for mer,χ2=0.940,P=0.332,the difference was NOT statistically significant.5.Subgroup analysis showed that negative staining of CDX2 had prognostic value in patients with lymph node metastasis,that the post-operative survival of positive expression was significantly longer than the negative ones.The difference was statistically significant(P=0.001).While NO correlation was been found between expression of CDX2 and prognosis of patients which had no lymph node metastasis,the difference was NOT statistically significant(P=0.617).Conclusion:1.The expression levels of CDX2 in colorectal cancer tissue and normal colorectal tissues have significant difference.The expression of CDX2 in colorectal cancer has shown being correlated with some clinical pathologic factors as like differentiation degree,left/right halfcolon location,lymph node metastas,and being correlated with the prognostic indicators as like 5-year survival rate,overall survival,progression-free survival,post-operative survival.The lack or down-regulation of CDX2 expression in colorectal cancer is associated with poor prognosis,especially in patients with positive lymph nodes metastasis.It may be used as a colorectal cancer biomarker of evaluatingand predicting prognosis.2.The expression of COX2 in colorectal cancer is up-regulated,but it is not correlated to colorectal cancer invasion,metastasis,OS and DFS.It is meaningle ss to prognosis of colorectal cancer.3.The inverse relationship has been shown for CDX2 expression and COX2 expression in colorectal cancer,which means that the lack or down-regulation of CDX2 expression may induce to activate the COX2 expression constantly,both of them involve in colorectal carcinoma may provide a new potential target for clinical accurate treatment.