胃癌原发灶及淋巴结Her2基因表达的差异性研究

A Differential Study on the Overexpression and Amplification of Her2 in Primary Gastric Cancer Lesions and Lymph Nodes

目的:明确胃癌原发灶与其转移淋巴结中Her2过表达或扩增的差异性,为临床胃癌治疗方案的选择提供参考依据。方法:选择112例经术后病理检查证实为胃癌原发灶Her2强阳性(Her2阳性表达为3+)表达并伴有淋巴结转移的患者样本,应用免疫组化方法并参照《胃癌Her2检测指南》中规定的检测流程重新判定有Her2过表达或扩增的胃癌原发病灶其相应的转移淋巴结中Her2有无过表达或扩增,再将检测结果进行比较。结果:112例患者中,胃癌组织Her2的阳性率为74.11%,淋巴结Her2的阳性表达为66.07%,二者共同阳性表达率为61.61%,差异无统计学意义(P=0.064)。两,二者一致率为83.04%,kappa检验结果为(Z=6.452,P<0.001)。胃癌组织Her2的基因表达与年龄、性别、肿瘤位置和肿瘤大小以及远端转移均无显著相关性,而与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:胃癌原发病灶中Her2过表达或扩增与其相应的转移淋巴结中Her2过表达或扩增具有一致性。胃癌组织Her2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。

Objective： To determine the differences between the overexpression or amplification of Her2 in primary lesions and that in metastatic lymph nodes, therefrom to guide the clinical treatment of gastric cancers. Methods： Immunohistochemical staining intensity of the primary lesions of 112 cases of gastric cancer patients were determined strong（＋＋＋）. The IHC method was adopted to re-test the primary lesions of 112 cases with Her2 overexpression or amplification and determined whether there was Her 2 overexpression or amplification in the corresponding metastatic lymph nodes by referring to the detection process in Guidelines for Her2 detection in gastric cancer, the testing results of which would then be compared. Results： The positive detection rates were respectively 74.11 %and 66.07 % in cancer tissues and lymph nodes, with the mutual detection rate of 61.61 % in 112 patients, no significant difference was found（P=0.064） by Mc Nemar chi-square test. The consistent rate was 83.04 %, and the result of kappa test was（Z=6.452, P0.001）.There was no evidence of correlation between gene expression in cancer tissue with the age, gender, location and size of tumor, and distant metastasis, but it was significantly associated with the Lauren type, tumor histological grade, depth of invasion, lymph node metastasis, and TNM stage. Conclusion： The overexpression or amplification of Her2 between primary gastric lesions and corresponding metastatic lymph nodes was coincident. Her2 gene expression in gastric cancer was significantly associated with Lauren type, tumor histological grade, depth of invasion, lymph node metastasis, and TNM stage.