人表皮生长因子受体 2 过表达的胃癌伴肝转移患者的预后。
Prognosis of HER2 over-expressing gastric cancer patients with liver metastasis.
机构信息
Department of Medical Oncology, General Hospital of the People's Liberation Army, Beijing 100853, China.
出版信息
World J Gastroenterol. 2012 May 21;18(19):2402-7. doi: 10.3748/wjg.v18.i19.2402.
AIM
To study the risk factors for liver metastasis and the prognosis in patients with human epidermal growth factor receptor 2 (HER2) over-expressing gastric cancer (GC).
METHODS
A total of 84 GC patients recruited from the General Hospital of the People's Liberation Army (PLA) between 2003 and 2010 were randomly enrolled in this study. HER2 expression was detected by immunohistochemistry in 84 GC patients with liver metastases. The study group consisted of 66 men and 18 women, with an average age of 54 years (range: 19-74 years). Liver metastasis was diagnosed by magnetic resonance imaging or computed tomography. Patients were followed-up and predictive factors of liver metastasis were evaluated.
RESULTS
The median follow-up period was 47 mo (range: 6-85 mo). The characteristics of 35 (25.7%) patients with HER2 over-expression of liver metastatic GC are presented. HER2 over-expression was detected in 23 out of 49 (46.9%) patients with intestinal GC, and 9 out of 35 (25.7%) patients with diffuse GC. 29 out of 59 (49.2%) patients aged < 60 years were HER2-positive, while 8 out of 25 (32%) patients aged ≥ 60 were HER2-positive; a significant difference (P < 0.05). Univariate analysis (log-rank test) showed that HER2 over-expression, sex, Lauren classification, differentiation and disease-free interval were correlated with poor survival (P < 0.05). Survival analysis with a survival curve showed that HER2 over-expression was significantly relevant, with a reduced survival time in GC patients with liver metastases (P < 0.01). 2-year survival was not associated with the patient's age. A disease-free survival longer than 12 mo has a significant association with extended overall survival (OS) in GC patients with liver metastases. The median survival time after the diagnosis of liver metastases was 18 mo [95% confidence interval (CI): 9.07-26.94] among HER2 positive GC patients with liver metastases. In comparison, for 49 (69.4%) out of 84 HER2 negative patients with liver metastatic GC, the median survival time was 47 mo (95% CI: 19.37-74.63). In patients with HER2 positive liver metastatic GC, the median OS was significantly shorter than in HER2 negative patients (median, 20.32 mo; 95% CI: 16.51-24.13 vs median, 50.14 mo; 95% CI: 37.83-62.45; P < 0.01).
CONCLUSION
HER2 over-expressing GC patients with liver metastases have a poor prognosis. Overall survival was significantly lower in HER2 positive patients. HER2-overexpression is correlated with a lower survival rate.
目的
研究人表皮生长因子受体 2（HER2）过表达的胃癌（GC）患者肝转移的危险因素和预后。
方法
本研究纳入了 2003 年至 2010 年间解放军总医院收治的 84 例 GC 患者。采用免疫组织化学法检测 84 例有肝转移的 GC 患者的 HER2 表达情况。研究组包括 66 名男性和 18 名女性，平均年龄为 54 岁（范围：19-74 岁）。通过磁共振成像或计算机断层扫描诊断肝转移。对患者进行随访，并评估肝转移的预测因素。
结果
中位随访时间为 47 个月（范围：6-85 个月）。有 35 例（25.7%）HER2 过表达肝转移性 GC 患者的特征。49 例肠型 GC 患者中有 23 例（46.9%）和 35 例弥漫型 GC 患者中有 9 例（25.7%）HER2 过表达。59 例年龄<60 岁的患者中有 29 例（49.2%）为 HER2 阳性，而 25 例年龄≥60 岁的患者中有 8 例（32%）为 HER2 阳性；差异有统计学意义（P<0.05）。单因素分析（log-rank 检验）显示，HER2 过表达、性别、Lauren 分类、分化程度和无病间期与生存不良相关（P<0.05）。生存曲线的生存分析显示，HER2 过表达与 GC 肝转移患者的生存时间缩短显著相关（P<0.01）。2 年生存率与患者年龄无关。无病生存期超过 12 个月与 GC 肝转移患者的总生存期延长显著相关。HER2 阳性肝转移 GC 患者的中位生存时间为 18 个月[95%可信区间（CI）：9.07-26.94]。相比之下，49 例（69.4%）HER2 阴性肝转移 GC 患者的中位生存时间为 47 个月（95%CI：19.37-74.63）。在 HER2 阳性肝转移 GC 患者中，中位 OS 明显短于 HER2 阴性患者（中位，20.32 个月；95%CI：16.51-24.13 与中位，50.14 个月；95%CI：37.83-62.45；P<0.01）。
结论
HER2 过表达的 GC 肝转移患者预后不良。HER2 阳性患者的总生存期明显较低。HER2 过表达与生存率降低相关。
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