Downregulated E-Cadherin Expression Indicates Worse Prognosis in Asian Patients with Colorectal Cancer: Evidence from Meta-AnalysisReport as inadecuate

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Epithelial-mesenchymal transition EMT plays a crucial role in the progression and aggressiveness of colorectal carcinoma. E-cadherin is the best-characterized molecular marker of EMT, but its prognostic significance for patients with CRC remains inconclusive.


Eligible studies were searched from the PubMed, Embase and Web of Science databases. Correlation between E-cadherin expression and clinicopathological features and prognosis was analyzed. Subgroup analysis was also performed according to study location, number of patients, quality score of studies and cut-off value.

Principal Findings

A total of 27 studies comprising 4244 cases met the inclusion criteria. Meta-analysis suggested that downregulated E-cadherin expression had an unfavorable impact on overall survival OS of CRC n = 2730 in 14 studies; HR = 2.27, 95%CI: 1.63–3.17; Z = 4.83; P = 0.000. Subgroup analysis indicated that low E-cadherin expression was significantly associated with worse OS in Asian patients n = 1054 in 9 studies; HR = 2.86, 95%CI: 2.13–3.7, Z = 7.11; P = 0.000 but not in European patients n = 1552 in 4 studies; HR = 1.14, 95%CI: 0.95–1.35, Z = 1.39; P = 0.165. In addition, reduced E-cadherin expression indicated an unfavorable OS only when the cut off value of low E-cadherin expression was >50% n = 512 in 4 studies; HR = 2.08, 95%CI 1.45–2.94, Z = 4.05; P = 0.000. Downregulated E-cadherin expression was greatly related with differentiation grade, Dukes- stages, lymphnode status and metastasis. The pooled OR was 0.3695%CI: 0.19–0.7, Z = 3.03, P = 0.002, 0.3495%CI: 0.21–0.55, Z = 6.61, P = 0.000, 0.4995%CI: 0.32–0.74, Z = 3.02, P = 0.002 and 0.4595%CI: 0.22–0.91, Z = 3.43, P = 0.001, respectively.


This study showed that low or absent E-cadherin expression detected by immunohistochemistry served as a valuable prognostic factor of CRC. However, downregulated E-cadherin expression seemed to be associated with worse prognosis in Asian CRC patients but not in European CRC patients. Additionally, this meta-analysis suggested that the negative threshold of E-cadherin should be >50% when we detected its expression in the immunohistochemistry stain.

Author: Xin He , Zhigang Chen , Minyue Jia, Xiaoying Zhao



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