胃癌原发灶与胃镜活检标本及淋巴结转移灶中Her-2状态的比较

Comparison of Her-2 status in primary gastric cancer with the corresponding endoscopic biopsies and lymph node metastases

目的:评估胃镜活检及转移淋巴结取样用于预测人类表皮生长因子受体2(Her-2)实际状态的准确性及有效性,并研究原发灶Her-2状态与胃癌临床病理特征的关系。方法:本研究按照《胃癌Her-2检测指南》中规定的检测流程对107例胃镜活检标本、手术标本及76例淋巴结转移灶的Her-2状态分别进行判读,将检测结果进行比较。结果:107例标本中胃镜活检标本与胃癌原发灶Her-2状态的一致率为86.9%,两类标本的Her-2状态具有一致性(Z=6.3813,P<0.000 1);76例有淋巴结转移的病例中原发灶与淋巴结转移灶Her-2状态的一致率为81.6%,二者的Her-2状态具有一致性(Z=3.0274,P=0.002 5);胃癌Her-2状态与Lauren分型、组织学分级、浸润深度、淋巴结转移以及TNM分期有关(P<0.05)。结论:胃镜活检标本及淋巴结转移灶与胃癌原发灶的Her-2状态具有较好的一致性,前两者能够较好的预测胃癌原发灶的Her-2状态;需要制定一个专门针对淋巴结转移灶的Her-2评分标准以完善胃癌的Her-2诊断系统;胃癌Her-2状态与肿瘤的浸润深度、淋巴结转移以及远处转移有关。

Objective：This study aimed to validate the accuracy and validity of Her- 2 assessment used for endoscopic biopsies and lymph node metastases by comparing these samples with the surgical materials obtained from the same patients. This study also aimed to analyze the relationship between primary tumor and clinicopathological characteristics of gastric cancer.Methods： Her- 2 sta-tus was evaluated according to Gastric cancer Her- 2 testing guidelines in 107 cases of gastric cancers with coupled endoscopic biopsies and surgical materials and in 76cases of the corresponding lymph node metastases. Results were then compared and analyzed. Re-sults： The complete concordance of the Her- 2 status of endoscopic biopsies and surgical samples （ n=107） was noted in 86.9% of the cases. This result is consistent between the two different samples （ Z=6.381 3, P〈0.000 1）. Primary gastric cancer and the corresponding lymph node metastases also displayed uniformity （ Z=3.027 4, P=0.002 5）. The positive rate of Her- 2 was significantly associated with Lauren type, tumor histological grade, depth of invasion, lymph node metastasis, and TNM stage. Conclusion：A high concordance was observed between primary tumor and biopsy specimen （endoscopic biopsies and lymph node metastases）, in which Her-2 status exhibit-ed a high predictive value. Her- 2 status is correlated with invasion and cancer metastasis. Hence, the most appropriate criteria for Her- 2 status assessment in lymph nodes should be considered to improve the Her-2 diagnosis system of gastric cancer.