Furthermore, a multivariate Cox regression analysis confirmed that local lymph node metastasis (P = 0.002), distant metastasis (P<0.001) and NKX2.1 expression (P = 0.005) could serve as independent predictors of the overall survival of patients with gastric carcinoma (Table 2). This evidence concerns the gene NKX2-1 and metastatic malignant neoplasm in the lymph nodes.