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Differential diagnostic and functional role of the multi-marker phenotype CDX2/CK20/CK7 in colorectal cancer stratified by mismatch repair status

Overview of attention for article published in Modern Pathology, June 2008
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Title
Differential diagnostic and functional role of the multi-marker phenotype CDX2/CK20/CK7 in colorectal cancer stratified by mismatch repair status
Published in
Modern Pathology, June 2008
DOI 10.1038/modpathol.2008.117
Pubmed ID
Authors

Alessandro Lugli, Alexandar Tzankov, Inti Zlobec, Luigi Maria Terracciano

Abstract

The differentiation of colorectal cancer from primary tumors at other sites can be challenging. Often a panel of immunohistochemical protein markers is needed to distinguish between these entities. Protein expression differs significantly in colorectal cancer depending on mismatch repair status and is also heterogeneous among mismatch repair-proficient or -deficient tumors. The aim of this study was to systematically analyze the diagnostic and prognostic role of the commonly used multi-marker phenotype CK20/CK7/CDX2 on a large series of colorectal cancers stratified by mismatch repair status. The immunohistochemical analysis of CK20, CK7 and CDX2 was performed on 1197 mismatch repair-proficient and 223 mismatch repair-deficient colorectal cancers using a tissue microarray. Multi-marker combinations of CK20/CK7/CDX2 were explored. Univariate and multivariable analysis of the markers was evaluated for their association with several clinico-pathological end points namely T stage, N stage, tumor grade, vascular invasion, intratumoral lymphocytes and survival. Multi-marker phenotypes with CK20 and CDX2 negativity were more frequently found in mismatch repair-deficient than in mismatch repair-proficient colorectal cancer (19.3 vs 7.5% and 21.6 vs 6.7%, respectively; P<0.001). In both colorectal cancer subsets loss of CK20 was associated with higher tumor grade (P<0.001) and with presence of intratumoral lymphocytes (P<0.001 and P=0.02, respectively). In the proficient mismatch repair subset CK20 overexpression was an independent adverse prognostic factor (P=0.041) and CDX2 underexpression was linked to tumor progression. Loss of CDX2 and CK20 is more frequently encountered in mismatch repair-deficient colorectal cancer, which should be taken into consideration to differentiate between primary and metastatic colorectal cancer in daily practice. Although associated with lower tumor grade, CK20 overexpression is an independent adverse prognostic factor in mismatch repair-proficient colorectal cancer.

Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 69 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Denmark 1 1%
Italy 1 1%
France 1 1%
Unknown 66 96%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 10 14%
Researcher 8 12%
Student > Postgraduate 7 10%
Student > Master 6 9%
Other 5 7%
Other 13 19%
Unknown 20 29%
Readers by discipline Count As %
Medicine and Dentistry 26 38%
Agricultural and Biological Sciences 6 9%
Biochemistry, Genetics and Molecular Biology 5 7%
Nursing and Health Professions 2 3%
Engineering 2 3%
Other 6 9%
Unknown 22 32%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 11 February 2010.
All research outputs
#8,535,684
of 25,374,917 outputs
Outputs from Modern Pathology
#1,696
of 3,283 outputs
Outputs of similar age
#33,717
of 96,206 outputs
Outputs of similar age from Modern Pathology
#8
of 27 outputs
Altmetric has tracked 25,374,917 research outputs across all sources so far. This one is in the 43rd percentile – i.e., 43% of other outputs scored the same or lower than it.
So far Altmetric has tracked 3,283 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.2. This one is in the 33rd percentile – i.e., 33% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 96,206 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 17th percentile – i.e., 17% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 27 others from the same source and published within six weeks on either side of this one. This one is in the 18th percentile – i.e., 18% of its contemporaries scored the same or lower than it.