Koltz B R, Hicks D G, Whitney-Miller C L
University of Rochester Medical Center, Department of Pathology and Laboratory Medicine, 601 Elmwood Avenue, Rochester, New York 14642, USA.
Biotech Histochem. 2012 Jan;87(1):40-5. doi: 10.3109/10520295.2011.591830. Epub 2011 Jul 12.
Adenocarcinomas of the esophagus and stomach constitute a substantial number of cancer cases worldwide. Most patients in the United States are diagnosed at an advanced or metastatic stage and, therefore, the prognoses have been poor. New treatments are needed to augment standard surgical and medical management. Recent studies have shown that a subset of esophageal and gastric adenocarcinomas overexpress the HER2 protein, similar to the overexpression seen in breast cancer. Because trastuzumab, a monoclonal antibody to the HER2 receptor, has been used with success in primary and HER2 positive metastatic breast cancers, the phase III ToGA trial was designed to assess the impact of trastuzumab in patients with HER2 positive gastric cancers. They have reported an increase in overall survival time for patients treated with chemotherapy and trastuzumab compared to those treated with chemotherapy alone. They have reported an increase in overall survival time for patients treated with chemotherapy and trastuzumab compared to those treated with chemotherapy alone. This means that accurate HER2 testing in gastric and esophageal carcinomas is necessary. While the breast cancer scoring system can be used to determine HER2 status in most cases, modifications are necessary to accommodate the heterogeneity and incomplete membrane staining that are observed more frequently in gastric cancers. An understanding of the scoring modifications is required for proper stratification of gastric cancer patients for treatment.
食管腺癌和胃腺癌在全球范围内占癌症病例的很大一部分。在美国，大多数患者在晚期或转移阶段才被诊断出来，因此预后很差。需要新的治疗方法来加强标准的手术和药物治疗。最近的研究表明，一部分食管和胃腺癌过度表达HER2蛋白，这与乳腺癌中观察到的过度表达情况相似。由于HER2受体单克隆抗体曲妥珠单抗已成功用于原发性和HER2阳性转移性乳腺癌，因此开展了III期ToGA试验，以评估曲妥珠单抗对HER2阳性胃癌患者的影响。他们报告称，与单纯接受化疗的患者相比，接受化疗和曲妥珠单抗治疗的患者总生存时间有所延长。这意味着对胃癌和食管癌进行准确的HER2检测是必要的。虽然乳腺癌评分系统在大多数情况下可用于确定HER2状态，但由于胃癌中更频繁观察到的异质性和不完全膜染色情况，需要进行修改。为了对胃癌患者进行适当的治疗分层，需要了解评分修改情况。
