人表皮生长因子受体2的表达与晚期胃癌患者临床病理特征及疗效和预后的关系  

HER-2 expression in advanced gastric cancer and its correlation with clinical features, outcome and prognosis

作　　者：王岩[1] 徐建明[1] 刘建芝[1] 林莉[1] 葛飞娇[1] 李珊珊[1] 刘烈军[1] 赵传华[1] 

机构地区：[1]军事医学科学院附属307医院消化肿瘤内科,北京100071

出　　处：《中华肿瘤杂志》2011年第9期671-675,共5页Chinese Journal of Oncology

摘　　要：目的研究晚期胃癌患者人表皮生长因子受体2（HER-2）的表达情况及其与胃癌临床病理特征、疗效和预后的相关性。方法采用免疫组化（ICH）法和（或）荧光原位杂交（FISH）法检测107例经病理学证实的晚期胃癌患者HER-2的表达情况，分析HER-2的表达与肿瘤部位、病理分型、胃癌疗效及预后之间的关系。总结晚期胃癌的治疗情况，比较不同化疗方案的疗效。结果107例患者中，有102例同时采用IHC法和FISH法检测了HER-2的表达情况，其阳性率为14．7％（15／102）。IHC法和FISH法检测HER-2阳性表达的一致率为66．5％。HER-2在胃食管连接部癌、近端胃癌、胃体癌、胃窦癌和全胃癌中的阳性表达率分别为15．4％、11．1％、13．3％、24．0％和0，差异无统计学意义（P=0．726），在低分化腺癌、中分化腺癌、高分化腺癌和分化不明的腺癌中的阳性表达率分别为15．3％、0、0和31．3％，差异亦无统计学意义（P=0．110）。一线化疗可评价疗效者51例，总体客观有效率为23．5％。患者的中位疾病进展时间（TTP）为7．47个月，中位总生存时间（OS）为11．07个月，其中采用含XP（顺铂＋卡培他滨）方案者的有效率明显高于其他方案（43．8％和14．3％，P=0．033），OS也呈延长趋势（14．17个月和9．53个月，P=0．059）。HER-2阳性表达者与阴性表达者相比，TTP差异无统计学意义（6．63个月和7．47个月，P=0．510），但疗效和OS均呈改善趋势，有效率分别为45．5％和17．5％（P=0．102），OS分别为14．17个月和10．63个月（P=0．205）。结论中国晚期胃癌患者的HER-2阳性率与国外报道相似。随着化疗和靶向药物的应用，晚期胃癌患者的疗效和预后均有所改善，而HER-2阳性患者可能更多获益。Objective To assess the HER-2 status in Chinese advanced gastric cancer patients and explore its correlation with clinical features, treatment response and prognosis. Methods A total of 107 patients with advanced gastric cancer treated in our hospital from December 2005 to November 2008 were included in this retrospective analysis. HER-2 status was determined by immunohistochemisty （IHC） and/or fluorescence in situ hybridization （FISH）. The correlations of HER-2 status with tumor location, pathology, treatment response and prognosis were analyzed and the efficacy of different chemottherapy regimens was compared. Results The overall positive rate of HER-2 expression was 14.7% （15/102）. The HER-2 status was detected by both methods in 102 patients, and the concordance of the two methods was 66.5%. The tumor site distribution was gastroesophageal junction （GEJ） 28.0%, proximal stomach 19.4%, gastric corpus 16.1%, antrum 26.9% and whole stomach 9.7%, respectively. There was no significant difference of HER-2 status among different tumor sites （ P = 0. 726 ）, and no significant correlation between HER-2 expression and differentiation （P = 0. 110 ）. Among the evaluable 51 patients treated by first-line chemotherapy, the total objective effective rate was 23.5%. The median time-to-progression was 7. 47 months, and median overall survival time was 11.07 months. The effective rate was 43.8% in patients who received XP regimen chemotherapy （cisplatin ＋ capecitabine）, significantly higher than the 14.3% in patients treated with other regimens （ P = 0. 033）. Their overall survival was 14.17 months and 9.53 months, respectively （ P = 0. 059）. The TTP was 6.63 months in HER-2 positive patients and 7.47 months in HER-2 negative patients, with a non-significant difference （P = 0.510）. However, there was a improving tendency in the efficacy and OS, showing a effectve rate of 45.5% and 17.5% （P = 0. 102） and OS of 14.17 months and 10.63 months, respectively （ P = 0. 205 ）. Conclusi

关 键 词：胃肿瘤 人表皮生长因子受体2 病理学 预后 药物疗法 

分 类 号：R735.2[医药卫生—肿瘤]