1 Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China ; 2 Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100730, China.
Chin J Cancer Res. 2015 Apr;27(2):163-71. doi: 10.3978/j.issn.1000-9604.2014.12.09.
A number of studies have examined human epidermal growth factor receptor 2 (HER2) status in primary gastric cancer (GC) and associated metastasis, some showed their great concordance in HER2 expression, but others demonstrated notable discordance. There is still little consensus on HER2 discordance, therefore, a systematic review and meta-analysis was conducted to assess the status on HER2 discordance between primary GC and its paired metastasis.
PubMed, EMBASE, ASCO and The Cochrane Library were searched for studies that explored the concordance between primary tumor and metastasis in patients with GC up to 10 March, 2014. Data of discordance of HER2 between primary GC and corresponding metastasis were extracted from the publications and random-effects models were used to estimate pooled discordance proportions.
Eighteen articles including 1,867 patients were included for the meta-analysis in accordance with the selection criteria. Pooled discordance proportions were 7% [95% confidence interval (CI): 5-10%] for HER2 status. Pooled proportions of tumors shifting from positive to negative and from negative to positive were 17% (95% CI: 7-29%) and 4% (95% CI: 2-6%) respectively. No publication bias was found in the meta-analysis.
The discordance of HER2 status is not rare in primary and metastatic GC through our meta-analysis. Prospective studies are needed to testify the clinical significance of the discordance of HER2 status.
许多研究已经检查了人表皮生长因子受体 2（HER2）在原发性胃癌（GC）及其相关转移中的状态，一些研究表明其在 HER2 表达方面具有很好的一致性，但其他研究则显示出明显的不一致性。HER2 不一致性仍存在较小的共识，因此，进行了系统评价和荟萃分析，以评估原发性 GC 与其配对转移之间 HER2 不一致性的状况。
检索了 PubMed、EMBASE、ASCO 和 Cochrane 图书馆，以查找截至 2014 年 3 月 10 日探讨 GC 患者中肿瘤与转移之间一致性的研究。从出版物中提取了原发性 GC 和相应转移中 HER2 不一致性的数据，并使用随机效应模型估计了汇总的不一致性比例。
根据选择标准，有 18 篇文章包括 1867 例患者被纳入荟萃分析。HER2 状态的汇总不一致性比例为 7%（95%置信区间：5-10%）。肿瘤从阳性转为阴性和从阴性转为阳性的汇总比例分别为 17%（95%置信区间：7-29%）和 4%（95%置信区间：2-6%）。荟萃分析中未发现发表偏倚。
通过荟萃分析，原发性和转移性 GC 中 HER2 状态的不一致性并不罕见。需要前瞻性研究来验证 HER2 状态不一致性的临床意义。
