Prognostic significance of CK7, CK20, and CDX2 expression in small intestinal adenocarcinoma.

@article{schafrat2026prognostic,
  title = {{Prognostic significance of CK7, CK20, and CDX2 expression in small intestinal adenocarcinoma.}},
  author = {P J M Schafrat and J D G Linssen and T R de Back and L E Nijman and M C S van der Heijden and N C T van Grieken and G Kazemier and P Drillenburg and M Chalabi and F N van Erning and I H J T de Hingh and R S A Goedegebuure and D W Sommeijer and A Farina Sarasqueta and L Vermeulen},
  journal = {ESMO gastrointestinal oncology},
  year = {2026},
  month = jun,
  doi = {10.1016/j.esmogo.2026.100346},
  url = {https://europepmc.org/article/MED/42948310},
  note = {CC BY},
}

TY  - JOUR
TI  - Prognostic significance of CK7, CK20, and CDX2 expression in small intestinal adenocarcinoma.
AU  - P J M Schafrat
AU  - J D G Linssen
AU  - T R de Back
AU  - L E Nijman
AU  - M C S van der Heijden
AU  - N C T van Grieken
AU  - G Kazemier
AU  - P Drillenburg
AU  - M Chalabi
AU  - F N van Erning
AU  - I H J T de Hingh
AU  - R S A Goedegebuure
AU  - D W Sommeijer
AU  - A Farina Sarasqueta
AU  - L Vermeulen
PY  - 2026
DA  - 2026/06/18
JO  - ESMO gastrointestinal oncology
DO  - 10.1016/j.esmogo.2026.100346
UR  - https://europepmc.org/article/MED/42948310
AB  - Background  Small intestinal adenocarcinoma (SIA) is a rare gastrointestinal malignancy for which prognostic biomarkers remain poorly defined. Immunohistochemical markers cytokeratin 7 (CK7), cytokeratin 20 (CK20), and caudal-type homeobox transcription factor 2 (CDX2) are diagnostic markers that are prognostic in other intestinal cancers, but their prognostic significance in SIA has not been studied before.Patients and methods  This nationwide, retrospective, population-based cohort study used data from the Netherlands Cancer Registry and the Dutch pathology database. Patients diagnosed with primary SIA between 1999 and 2019 and with registered CK7, CK20, or CDX2 expression levels were included. Overall survival (OS) was analyzed using Kaplan-Meier curves and multivariable Cox regression models adjusted for age, sex, stage, tumor location, and treatment. The findings were validated in a detailed cohort of 128 SIA patients.Results  Of 2697 patients diagnosed with SIA, expression data were available for 691 patients. CK7 positivity was associated with more proximal, advanced, and microsatellite stable tumors. CK7-negative, CK20-positive, and CDX2-positive tumors demonstrated significantly improved OS (all P ≤ 0.002). In multivariable analysis, lack of CK20 and CDX2 expression were independent predictors of poorer survival [hazard ratio (HR) 1.37, 95% confidence interval (CI) 1.02-1.83 and HR 1.51, 95% CI 1.06-2.17, respectively]. Combined expression profiles identified distinct prognostic subgroups, which were confirmed in the validation cohort.Conclusion  CK20 and CDX2 expression are independent prognostic biomarkers in SIA, regardless of primary tumor location. Their assessment may improve risk stratification and refine disease classification, bridging diagnostic and prognostic utility in this rare cancer type.
SN  - 2949-8198
ER  -