Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Division of Pathology, National Cancer Center Hospital East, Kashiwa, Japan.
Surg Endosc. 2018 Sep;32(9):3964-3971. doi: 10.1007/s00464-018-6138-8. Epub 2018 Mar 2.
Human epidermal growth factor receptor 2 (HER2) expression in gastric cancer is highly heterogeneous. Therefore, it is important to take endoscopic samples from appropriate tumor sites.
Between January 2008 and April 2015, patients with gastric or gastroesophageal junction cancer with histologically confirmed adenocarcinoma were included. Surgical samples or endoscopic biopsy samples were examined for HER2 using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Tissues were considered to be HER2 positive when either assessment revealed either an IHC score of 3+ or an IHC score of 2+ accompanied by a positive FISH result. Endoscopic findings were retrieved in all cases where available, and we examined the portion from which a biopsy was obtained.
Out of the 612 patients included in the study, 104 (17%) were HER2 positive. The proportion of HER2-positive gastric tumors with differentiated (vs. undifferentiated) histology was significantly higher (29 vs. 6%, respectively; p < 0.001). The HER2-positive rate of papillary adenocarcinomas (vs. tubular) was particularly high (62%, 8/13; p = 0.023). The proportion of HER2-positive gastric tumors of Borrmann classification 0 or 1 was significantly higher than that of tumors of classified as 2, 3, or 4 (45 vs. 16%, respectively; p < 0.001). The HER2-positive rates per biopsy specimen from the superficial spreading portion, ulcer mound, ulcer bed, and mass portion were 100, 91, 45, and 100%, respectively.
HER2-positive gastric cancer tends to be associated with a differentiated histology, particularly papillary adenocarcinoma, and a Borrmann classification of 0 or 1 tumors. Based on these endoscopic findings, it is important to recognize the superficial spreading portion and the mass portion of gastric malignancies.
人表皮生长因子受体 2（HER2）在胃癌中的表达具有高度异质性。因此，从适当的肿瘤部位获取内镜样本非常重要。
本研究纳入了 2008 年 1 月至 2015 年 4 月期间经组织学证实为腺癌的胃或胃食管交界处癌患者。采用免疫组织化学（IHC）和荧光原位杂交（FISH）检测手术标本或内镜活检标本的 HER2。当评估结果显示 IHC 评分 3+或 IHC 评分 2+伴有阳性 FISH 结果时，将组织判断为 HER2 阳性。在所有可获取内镜检查结果的病例中，均检索了内镜检查结果，并检查了活检取材部位。
在纳入研究的 612 例患者中，有 104 例（17%）HER2 阳性。HER2 阳性胃肿瘤中，分化型（vs. 未分化型）的比例明显更高（分别为 29%和 6%，p<0.001）。乳头状腺癌（vs. 管状腺癌）的 HER2 阳性率特别高（62%，8/13；p=0.023）。Borrmann 分类为 0 或 1 的胃肿瘤中，HER2 阳性的比例明显高于 Borrmann 分类为 2、3 或 4 的肿瘤（分别为 45%和 16%，p<0.001）。从黏膜内广泛扩散型、溃疡隆起型、溃疡底型和肿块型取材的活检标本中，HER2 阳性率分别为 100%、91%、45%和 100%。
HER2 阳性胃癌往往与分化型组织学相关，特别是乳头状腺癌和 Borrmann 分类为 0 或 1 的肿瘤。基于这些内镜表现，重要的是要识别胃恶性肿瘤的黏膜内广泛扩散型和肿块型。
