{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T18:38:23Z","timestamp":1792694303869,"version":"4.5.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["20837893"],"award-info":[{"award-number":["20837893"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Surg Pathol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>CDX2 is a transcription factor critical for intestinal development and differentiation. While its prognostic value is established in colorectal cancer, its significance in pancreatic ductal adenocarcinoma (PDAC) remains unclear. Given the overlap of intestinal-type features in intraductal papillary mucinous neoplasms (IPMNs), clarifying the role of CDX2 in PDAC and IPMN may provide insights into tumor biology and prognostic markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 35 PDAC and 42 IPMN-associated carcinoma (IPMC) resected lesions. Immunohistochemistry for CDX2 and intestinal differentiation markers (ATOH1, MUC2, GPA33) was performed. CDX2 expression was semi-quantified using an H-score derived from whole-slide image analysis with QuPath. Associations between CDX2 expression and disease-free survival (DFS) were assessed using Kaplan\u2013Meier and Cox regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CDX2 expression was observed in 43% of PDAC and 50% of IPMC. In IPMC, CDX2 positivity was often accompanied by downstream markers, suggesting preserved intestinal-type differentiation. In contrast, CDX2-positive PDAC rarely expressed GPA33 or MUC2, indicating divergence from the intestinal cascade. Higher CDX2 H-scores were significantly associated with lower recurrence (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.027). ROC analysis showed fair predictive ability with an AUC of 0.74 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.008). Although multivariate analysis was not significant, subgroup analysis showed that in PDAC with lymph node metastasis, high CDX2 expression was associated with longer DFS (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.014).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Digitally quantified CDX2 expression may serve as a favorable prognostic biomarker in PDAC, distinct from its role in maintaining intestinal-type differentiation in IPMN. Validation in larger, multicenter cohorts is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10668969261437128","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:38:18Z","timestamp":1775561898000},"page":"1498-1508","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of Digitally Quantified CDX2 Expression in Pancreatic Ductal Adenocarcinoma Without Intestinal Differentiation"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6471-3593","authenticated-orcid":false,"given":"Masato","family":"Endo","sequence":"first","affiliation":[{"name":"University of Tsukuba"},{"name":"Graduate School of Comprehensive Human Sciences, University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Niisato","sequence":"additional","affiliation":[{"name":"University of Tsukuba"},{"name":"Graduate School of Comprehensive Human Sciences, University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Shimomura","sequence":"additional","affiliation":[{"name":"University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriaki","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shohei","family":"Sugita","sequence":"additional","affiliation":[{"name":"University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"University of Tsukuba"},{"name":"Graduate School of Comprehensive Human Sciences, University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soma","family":"Fukuda","sequence":"additional","affiliation":[{"name":"University of Tsukuba"},{"name":"Graduate School of Comprehensive Human Sciences, University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Matsubara","sequence":"additional","affiliation":[{"name":"University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Oda","sequence":"additional","affiliation":[{"name":"University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-8707","authenticated-orcid":false,"given":"Kiichiro","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"University of Tsukuba"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41568-021-00418-1"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAT.0b013e3283445e3a"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2011.12.042"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.4103\/1947-2714.157477"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.11.029"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-005-0039-7"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2010.210567"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/cas.14755"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.4161\/cbt.3.7.913"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.devcel.2009.02.010"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/path.1246"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200303000-00003"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1158\/1535-7163.Mct-17-1086"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/19420862.2020.1714371"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1021\/acs.molpharmaceut.0c00210"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.10.1465"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506597"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2023.102643"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3800698"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13277-013-0919-4"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.12278"},{"issue":"6","key":"e_1_3_3_23_2","first-page":"1239","article-title":"CDX2 expression in pancreatic tumors: relationship with prognosis of invasive ductal carcinomas","volume":"12","author":"Matsumoto K","year":"2004","unstructured":"Matsumoto K, Mizoshita T, Tsukamoto T, et al. 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