Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Department of Surgery, National Hospital Organization Satsunan Hospital, Minami Satsuma, Japan.
Cancer Chemother Pharmacol. 2021 Jun;87(6):789-797. doi: 10.1007/s00280-021-04251-z. Epub 2021 Feb 28.
The prognosis of metastatic gastric cancer has improved due to trastuzumab in patients with HER2 positive. Circulating tumor cells (CTCs) have been examined as a prognostic predictor in gastric cancer. The clinical advantage of trastuzumab was examined in gastric cancer patients with HER2-negative tumor tissues and HER2-positive CTCs.
A total of 105 patients with metastatic or recurrence gastric cancer were enrolled. All patients were examined HER2 expression in CTC using the CellSearch system in blood specimens.
CTCs were detected in 65 of 105 patients (61.9%) and 61 patients were divided into three groups: Group A (n = 27), histological HER2-positive; Group B (n = 17), histological HER2-negative and HER2-positive CTCs; and Group C (n = 17), HER2-negative on histology and CTCs. Patients received capecitabine plus cisplatin. Groups A and B were additionally treated by trastuzumab. There was no relationship between tumor tissues and CTCs in HER2 expression. Even if group B had no histological HER2 expression, group B showed a good prognosis as same as group A, and group C had a significantly worse overall survival than groups A and B. The multivariate analysis demonstrated that HER2-expression on CTCs was an independent prognostic factor for both overall and progression-free survival.
The present results indicate the potential clinical utility of trastuzumab combined chemotherapy in patients with HER2-positive CTCs even if they are histologically HER2-negative.
曲妥珠单抗使 HER2 阳性转移性胃癌患者的预后得到改善。循环肿瘤细胞（CTC）已被作为胃癌的预后预测因子进行了研究。本研究旨在探讨曲妥珠单抗在 HER2 阴性肿瘤组织和 HER2 阳性 CTC 患者中的临床获益。
共纳入 105 例转移性或复发性胃癌患者。所有患者均采用 CellSearch 系统检测血样中 CTC 的 HER2 表达。
105 例患者中有 65 例（61.9%）检测到 CTC，其中 61 例患者分为三组：A 组（n=27），组织学 HER2 阳性；B 组（n=17），组织学 HER2 阴性且 CTC 阳性；C 组（n=17），组织学 HER2 阴性且 CTC 阴性。患者接受卡培他滨联合顺铂治疗。A 组和 B 组加用曲妥珠单抗治疗。肿瘤组织和 CTC 之间的 HER2 表达无相关性。即使 B 组组织学上无 HER2 表达，B 组的预后与 A 组一样良好，而 C 组的总生存期明显劣于 A 组和 B 组。多因素分析表明，CTC 上的 HER2 表达是总生存期和无进展生存期的独立预后因素。
即使组织学上为 HER2 阴性，HER2 阳性 CTC 患者联合化疗加用曲妥珠单抗可能具有潜在的临床应用价值。
