Caudal-type homeobox 2 (CDX2), special AT-rich sequence-
binding protein 2 (SATB2), and
keratin 20 (KRT20) are frequently used as intestinal epithelium-specific markers in immunohistochemical studies. However, subsets of
colorectal carcinomas (
CRCs) show loss of these markers. We analyzed The
Cancer Genome Atlas data to explore molecular correlates of CDX2, SATB2, and KRT20 genes in 390
CRCs. The decreased
mRNA expression of each of the three genes commonly correlated with
microsatellite instability-high (MSI-H), CpG island methylator phenotype-high (CIMP-H), BRAF/RNF43 mutations, consensus molecular subtype 1, and high
tumor mutational burden. The downregulation of CDX2 or SATB2 was dependent on both MSI-H and CIMP-H, whereas that of KRT20 was more dependent on MSI-H than on CIMP-H. Next, we evaluated the immunohistochemical expression of CDX2, SATB2, and KRT20 in 436 primary
CRCs. In contrast to
RNA-level expression, decreased expression of CDX2 and SATB2 was more dependent on CIMP-H than on MSI-H. However, consistent with
RNA-level expression, decreased expression of KRT20 was more dependent on MSI-H than on CIMP-H. CIMP-H and lymphatic invasion were consistently associated with both CDX2 loss and SATB2 loss in
CRCs, regardless of MSI status. In microsatellite stable
CRCs, CDX2 loss correlated with BRAF mutation, whereas SATB2 loss was associated with KRAS mutations and decreased T-cell infiltration. Cases with concurrent loss of all three markers were found exclusively in MLH1-methylated MSI-H/CIMP-H
CRCs. In conclusion, MSI-H and/or CIMP-H are major common correlates of decreased CDX2/SATB2/KRT20 expression in
CRCs, but the specific features associated with the loss of each marker are different in
CRCs.