Gupta P, Rao S, Bhalla S
Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India.
Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India.
Indian J Cancer. 2016 Oct-Dec;53(4):505-511. doi: 10.4103/ijc.IJC_513_16.
Gastric carcinoma is a leading cause of death worldwide with a five year survival of 10-15% even after curative resection. Trastuzumab has emerged as a potential targeted therapy in treatment of Her 2 positive gastric cancer. Her2 positivity ranges from 7-34% in studies across the world. There is a paucity of Indian studies hence a need for determination of Her2 expression in Indian population for better patient management. This study was carried out to determine the frequency of Her 2 expression in gastric carcinoma by immunohistochemistry (IHC) technique and to evaluate its association with histopathological parameters.
A total of 110 cases of gastric adenocarcinoma diagnosed on histopathological examination from July 2013 to June 2015 were included. Of these, 40 cases were resection specimens and 70 were biopsies. Histological typing of gastric carcinoma was done on the basis of Lauren classification. IHC for Her2 was done in all 110 cases. Her 2 expression was correlated with various histopathological parameters.
Positive Her 2 expression (IHC 3+) was seen in 24.5% cases of gastric carcinoma. Patients in older age group(> 60 years) showed higher Her 2 positivity rate as compared to middle age (40-60 years) and younger population (<40 years). Higher percentage of Her 2 positivity was noted in male patients as compared to female patients. Her 2 positivity was seen more commonly in intestinal type of tumor as compared to diffuse and mixed types. Her 2 positivity was seen more in well differentiated carcinoma and higher stage tumors (pT3 and pT4). However, out of all, a statistically significant association of Her2 expression was found only with (intestinal) type of tumors (p= 0.005) and no significant association was seen with age, gender, site of tumor, tumor stage, lymph node status, lymphovascular, perineural and perinodal invasion or survival.
Inspired by promising results of Trastuzumab therapy in Her 2 positive gastric carcinoma worldwide, it is recommended to routinely test all cases of gastric carcinoma for Her 2 expression and to use the targeted therapy with curative intentions in Indian population.
胃癌是全球主要的死亡原因之一，即使在根治性切除术后，五年生存率也仅为10%-15%。曲妥珠单抗已成为治疗人表皮生长因子受体2（Her2）阳性胃癌的一种潜在靶向治疗药物。在全球范围内的研究中，Her2阳性率在7%-34%之间。印度的相关研究较少，因此有必要确定印度人群中Her2的表达情况，以便更好地管理患者。本研究旨在通过免疫组织化学（IHC）技术确定胃癌中Her2表达的频率，并评估其与组织病理学参数的相关性。
纳入2013年7月至2015年6月期间经组织病理学检查确诊的110例胃腺癌病例。其中，40例为切除标本，70例为活检标本。根据劳伦分类法对胃癌进行组织学分型。对所有110例病例进行Her2的免疫组织化学检测。将Her2表达与各种组织病理学参数进行相关性分析。
24.5%的胃癌病例中可见Her2阳性表达（免疫组织化学3+）。与中年（40-60岁）和年轻人群（<40岁）相比，老年组（>60岁）患者的Her2阳性率更高。男性患者的Her2阳性率高于女性患者。与弥漫型和混合型肿瘤相比，肠型肿瘤中Her2阳性更为常见。高分化癌和晚期肿瘤（pT3和pT4）中Her2阳性更为多见。然而，总体而言，仅发现Her2表达与（肠）型肿瘤存在统计学显著相关性（p=0.005），而与年龄、性别、肿瘤部位、肿瘤分期、淋巴结状态、淋巴管、神经周围和淋巴结周围浸润或生存率均无显著相关性。
受全球曲妥珠单抗治疗Her2阳性胃癌的良好结果启发，建议对所有胃癌病例常规检测Her2表达，并在印度人群中使用靶向治疗以达到治愈目的。
