进展期胃癌人表皮生长因子受体2蛋白表达与临床病理学特征的关系

Relationship between HER2 expression and clinicopathological features in advanced gastric cancer

目的:评估人表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)蛋白在胃癌中的表达情况,并分析其与胃癌患者临床病理学特征间的关系。方法:收集2011年至2015年在瑞金医院行手术切除的胃癌患者的组织标本,检测其中HER2蛋白的表达情况,并分析患者的临床病理学特征与其HER2蛋白表达间的关系。结果:142例胃癌患者的病理组织中HER2蛋白表达呈阳性[免疫组织化学(immunohis tochemistry,IHC)3+],且HER2蛋白阳性表达与其局部浸润深度(P=0.002)、淋巴结转移(P<0.001)及TNM分期(P=0.030)相关。根据Lauren's分型,肠型胃癌(30.5%)中的HER2蛋白阳性表达率高于弥漫型胃癌(16.1%,P<0.05);而根据WHO分类标准,高-中分化胃癌(43.0%)中的HER2蛋白阳性表达率高于低-未分化胃癌(22.8%,P<0.05)。结论:建立标准化的胃癌HER2蛋白免疫组织化学染色评分体系标准,对于筛选适合使用曲妥珠单抗治疗的患者显得尤为重要。肠型胃癌、高-中分化、TNM分期晚的胃癌患者的HER2蛋白阳性率明显高于其他胃癌患者,而这一部分患者可能从曲妥珠单抗靶向治疗中获益。

Objective：To investigate the expression of human epidermal growth factor receptor-2（HER2） in advanced gastric cancer and the correlation between HER2 expression and clinicopathological features. Methods：A total of542 consecutive patients with gastric cancer from 2011 to 2015 were enrolled,and all the patients received resection of the tumor at Ruijin Hospital. HER2 expression in tumor tissue was detected by immunohistochemistry in accordance with the Hoffmann scoring system. Correlation between HER2 expression and clinicopathological features was statistically ana-lyzed. Results：One hundred and forty-one cases（26%） were scored as strongly positive for HER2 membrane staining（3＋）.HER2 positivity was statistically associated with local invasion（P=0.002）,lymph node metastasis（P〈0.001）,and TNM staging（P=0.030）,respectively. HER2 overexpression was more frequently detected in intestinal（30.5%） than that in dif-fuse（16.1%） type of tumor according to Lauren＇s classification. Similarly,HER2 overexpression was more frequently de-tected in well or moderate differentiated（43.0%） than in poor or undifferentiated（22.8%） tumor according to WHO classi-fication. Conclusions：An accurate standardized scoring system for HER2 expression in gastric cancer patients is impor-tant for selecting patients for trastuzumab treatment. This study indicates that patients with intestinal type,well differen-tiated and late staging hare a high rate of HER2 expression,and they were the candidates for targeted therapy using trastuzumab.