Expression of CDX-2 and ALK in primary gastric carcinoma: correlation with Her-2/neu status and prognostic factors

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Gastric carcinoma still represents a serious health problem. Prognostic biomarkers that predict the disease outcome and aid in better treatment options are of great value. Intestinal differentiation marker, caudal type homeobox-2 (CDX-2), and tumorigenic marker, anaplastic lymphoma kinase (ALK), may have influence on tumor behavior and prognosis.


The aim of this study was to analyze the expression of CDX-2 and ALK in relation to Her-2 status and clinicopathological factors of gastric carcinoma to assess the prognostic significance of combined biomarkers expression.

Materials and methods

Immunohistochemical expression of CDX-2 and ALK was studied in 68 paraffin-embedded specimens of primary gastric carcinoma.


CDX-2 and ALK expressions were detected in 58.5 and 11.8% of studied cases, respectively. CDX-2 expression was significant in intestinal type tumors (P=0.0001). A significant negative correlation was found between CDX-2 expression and tumor differentiation (P=0.003), pT stage (P=0.0001), lymph node metastasis (P=0.005), and Her-2 expression (P=0.042), whereas ALK expression was significantly more in diffuse type (P=0.023). A significant positive correlation was observed between ALK-positive tumors and degree of tumor differentiation (P=0.006), lymph node metastasis (P=0.011), and Her-2 expression (P=0.029). A significant negative relation was detected between CDX-2 and ALK expressions (P=0.039).


Combined expressions of CDX-2 and ALK in gastric carcinoma allow the classification of patients into groups with different prognosis, clinical outcomes, and treatment options. CDX-2+/ALK− cases were significantly associated with favorable prognostic factors.

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