HER2阳性胃癌患者的临床特征与术后预后分析

Clinical characteristics and prognosis analysis of patients with HER2 positive gastric cancer

目的探讨人表皮生长因子受体2(HER2)与胃癌患者的临床病理特征的相关性及术后预后价值。方法回顾性分析2011年6月—2016年12月于东南大学附属江阴市人民医院胃肠外科施行开腹根治性胃切除手术的543例胃腺癌患者的临床病理资料,其中男404例,女139例,年龄26~84岁。根据癌组织HER2免疫组织化学染色结果,将患者分为HER20+组(n=427)、HER21+组(n=56)、HER22+组(n=29)和HER23+组(n=31),比较4组在临床病理指标上的差异。进一步将HER20+组和HER21+组胃癌患者合并为HER2阴性组(n=26),HER23+作为HER2阳性组(n=26),应用倾向评分匹配法均衡两组与预后相关的基本资料变量,采用Kaplan-Meier法进行生存分析,采用Cox风险回归模型分析与HER2阳性胃癌患者术后生存相关的危险因素。结果全组胃癌患者中HER2过表达比率5.7%(31/543)。HER2表达水平与性别(χ^(2)=8.30,P=0.040)、肿瘤纵向部位(χ^(2)=22.86,P=0.029)、组织学分化(χ^(2)=13.27,P=0.004)有相关性;中位生存时间与HER2表达水平之间差异无统计学意义(χ^(2)=5.44,P=0.142)。倾向评分匹配后,HER2阳性组胃癌中位生存时间23个月,单因素和多因素分析结果显示血型(HR:1.619,95%CI:1.081~2.423,P=0.019)是影响HER2阳性胃癌预后的独立危险因素。结论HER2在男性、贲门胃底部及高、中分化的胃腺癌中表达较高,但HER2表达水平与胃癌中位生存时间无显著相关性,ABO血型可能是影响HER2阳性胃癌生存的独立危险因素。

ObjectiveTo investigate the correlation of human epidermal growth receptor 2(HER2)with clinicopathological characteristics and its postoperative prognostic value in patients with gastric cancer.Methods The clinicopathological data of 543 patients with gastric cancer who underwent open radical gastrectomy were retrospectively analyzed in the Gastrointestinal Surgery Department of Jiangyin People's Hospital Affiliated to Southeast University from June 2011 to December 2016,including 404 males and 139 females,aged from 26 to 84 years old.According to the results of HER2 immunohistochemical staining,gastric cancer patients were divided into HER20+group(n=427),HER21+group(n=56),HER22+group(n=29)and HER23+group(n=31),and the differences in clinicopathological indicators of the four groups were compared.Furthermore,HER20+and 1+gastric cancer patients were classified as HER2-negative group(n=26),and HER23+as HER2-positive group(n=26).Propensity score matching method was used to balance the basic data variables related to prognosis of the two groups,and Kaplan-Meier method was used for survival analysis.Cox risk regression model was used to analyze the risk factors associated with postoperative survival in patients with HER2-positive gastric cancer.ResultsThe overexpression rate of HER2 in gastric cancer patients was 5.7%(31/543).The expression level of HER2 was significantly correlated with gender(χ^(2)=8.30,P=0.040),tumor longitudinal location(χ^(2)=22.86,P=0.029)and histological differentiation(χ^(2)=13.27,P=0.004).There was no significant correlation between median survival time and HER2 expression level(χ^(2)=5.44,P=0.142).After propensity score matching,the median survival time of gastric cancer in the HER2-positive group was 23 months.Univariate and multivariate analysis showed that ABO blood group(HR:1.619,95%CI:1.081-2.423,P=0.019)was an independent risk factor for prognosis of HER2-positive gastric cancer.ConclusionThe expression of HER2 is higher in men,cardia fundus and high and medium differentiated gastric adenocarcinoma,but there is no significant correlation between the expression level of HER2 and the median survival time of gastric cancer.ABO blood group may be an independent risk factor for the survival of HER2-positive gastric cancer.