表皮生长因子II型受体（HER2/neu）过表达中的种族差异：子宫浆液性乳头状癌的主要预后指标

Racial differences in the overexpression of epidermal growth factor type II receptor (HER2/neu): a major prognostic indicator in uterine serous papillary cancer.

作者信息

Santin Alessandro D, Bellone Stefania, Siegel Eric R, Palmieri Michela, Thomas Maria, Cannon Martin J, Kay Helen H, Roman Juan J, Burnett Alexander, Pecorelli Sergio

机构信息

Division of Gynecologic Oncology, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA.

出版信息

Am J Obstet Gynecol. 2005 Mar;192(3):813-8. doi: 10.1016/j.ajog.2004.10.605.

DOI:10.1016/j.ajog.2004.10.605

PMID:15746676

Abstract

OBJECTIVE

A difference in survival rates between black and white patients with cancer of the corpus uteri is well established. This study was conducted to determine whether the overexpression of HER2/neu oncogene is associated with poor outcome in uterine serous papillary endometrial cancer, which is a highly aggressive variant of endometrial cancer, and whether a racial difference in the frequency of HER2/neu overexpression may contribute to the disparity in endometrial cancer survival.

STUDY DESIGN

Immunohistochemical evaluation was used to examine HER2/neu expression in paraffin blocks from 27 women with stage IA to IV uterine serous papillary endometrial cancer. Univariable analysis was performed and followed by multivariable analysis with Cox's proportional hazard model to evaluate whether HER2/neu expression was associated with poor outcome in uterine serous papillary endometrial cancer.

RESULTS

Black patients tended to be younger (P = .02) and have higher HER2/neu expression than white patients (trend P = .02). Seven of 10 black patients (70%) showed heavy (3+) expression, compared with 4 of 17 white patients (24%; P = .04). The association of heavy HER2/neu expression with race persisted after age was controlled through stratification (P = .05). Earlier deaths from uterine serous papillary endometrial cancer were seen among heavy HER2/neu expressers (P = .002), black patients (P = .04), and patients < or = 65 years old (P = .04). However, multivariate Cox regression showed that short survival was associated significantly with heavy HER2/neu expression (P = .02) but not with age (P = .07) or race (P = .35), which indicates that HER2/neu expression accounted for much of the race disparity in survival in this patient population.

CONCLUSION

Overexpression of HER2/neu in uterine serous papillary endometrial cancer is an independent variable that is associated with poor outcome, occurs more frequently in black women, and may contribute to racial disparity in survival. HER2/neu expression may guide clinical treatment of patients with uterine serous papillary endometrial cancer and may have implications for the implementation of novel treatment strategies.

摘要

目的

子宫体癌患者中，黑人与白人的生存率差异已得到充分证实。本研究旨在确定HER2/neu癌基因的过表达是否与子宫浆液性乳头状子宫内膜癌（子宫内膜癌的一种高度侵袭性变体）的不良预后相关，以及HER2/neu过表达频率的种族差异是否可能导致子宫内膜癌生存率的差异。

研究设计

采用免疫组织化学评估法检测27例IA期至IV期子宫浆液性乳头状子宫内膜癌患者石蜡块中的HER2/neu表达。进行单变量分析，随后采用Cox比例风险模型进行多变量分析，以评估HER2/neu表达是否与子宫浆液性乳头状子宫内膜癌的不良预后相关。

结果

黑人患者往往比白人患者年轻（P = 0.02），且HER2/neu表达更高（趋势P = 0.02）。10例黑人患者中有7例（70%）显示强阳性（+++）表达，而17例白人患者中有4例（24%）显示强阳性表达（P = 0.04）。通过分层控制年龄后，HER2/neu强阳性表达与种族的关联依然存在（P = 0.05）。HER2/neu强阳性表达者（P = 0.002）、黑人患者（P = 0.04）以及年龄≤65岁的患者（P = 0.04）中，子宫浆液性乳头状子宫内膜癌导致的早期死亡更为常见。然而，多变量Cox回归显示，生存期短与HER2/neu强阳性表达显著相关（P = 0.02），但与年龄（P = 0.07）或种族（P = 0.35）无关，这表明在该患者群体中，HER2/neu表达是生存率种族差异的主要原因。