HER2 heterogeneity is a poor prognosticator for HER2-positive gastric cancer

BACKGROUND The clinical significance of intratumoral human epidermal growth factor receptor 2(HER2)heterogeneity is unclear for HER2-positive gastric cancer,although it has been reported to be a significant prognosticator for HER2-positive breast cancer,which has received trastuzumab-based chemotherapy.AIM To clarify the clinical significance of intratumoral HER2 heterogeneity for HER2-positive gastric cancer,which has received trastuzumab-based chemotherapy.METHODS Patients with HER2-positive unresectable or metastatic gastric cancer who received trastuzumab-based chemotherapy as a first line treatment were included.The patients were classified into two groups according to their intratumoral HER2 heterogeneity status examined by immunohistochemistry(IHC)on endoscopic biopsy specimens before treatment,and their clinical response to chemotherapy and survival were compared.RESULTS A total of 88 patients were included in this study,and HER2 heterogeneity was observed in 23(26%)patients(Hetero group).The overall response rate was significantly better in patients without HER2 heterogeneity(Homo group)(Homo vs Hetero:79.5%vs 35.7%,P=0.002).Progression-free survival of trastuzumab-based chemotherapy was significantly better in the Homo group(median,7.9 vs 2.5 mo,HR:1.905,95%CI:1.109-3.268).Overall survival was also significantly better in the Homo group(median survival time,25.7 vs 12.5 mo,HR:2.430,95%CI:1.389-4.273).Multivariate analysis revealed IHC HER2 heterogeneity as one of the independent poor prognostic factors(HR:3.115,95%CI:1.610-6.024).CONCLUSION IHC of HER2 heterogeneity is the pivotal predictor for trastuzumab-based chemotherapy.Thus,HER2 heterogeneity should be considered during the assessment of HER2 expression.

Erratum: Author’s Affiliation Correction. Type Ⅱ human epidermal growth factor receptor heterogeneity is a poor prognosticator for type Ⅱ human epidermal growth factor receptor positive gastric cancer (World J Clin Cases 2019;Aug 6;7 (15): 1964-1977)

Correction to"Type II human epidermal growth factor receptor heterogeneity is a poor prognosticator for type II human epidermal growth factor receptor-positive gastric cancer"World J Clin Cases 2019;7(15):1964-1977.In this article,one of the affiliation of the first author was lacked.Akio Kaito,the first author,belonged to Course of Advanced Clinical Research of Cancer,Juntendo University Graduate School of Medicine,Tokyo 163-8001,Japan.

Robotic gastrectomy for gastric cancer

Robotic gastrectomy(RG)is increasingly performed,particularly in East Asia.With articulated devices,surgeons are able to perform every procedure more comfortably and meticulously,which makes RG ideal from the surgeon’s standpoint.However,it is still unclear whether it is a suitable treatment strategy from the patient’s viewpoint,due to the lack of solid evidence obtained from randomized controlled trials.The feasibility of RG has been demonstrated in many retrospective comparative studies,which showed similar trends,including relatively less estimated blood loss and longer operation time with RG than laparoscopic gastrectomy(LG),equivalent number of harvested lymph nodes and similar length of postoperative hospital stay between RG and LG.However,considering the higher medical expenses associated with RG,its superiority in terms of long-term survival outcomes will need to be confirmed for it to be accepted more widely.