Department of Internal Medicine, Division of Medical Oncology.
Departments of Surgery.
Am J Clin Oncol. 2021 Jun 1;44(6):232-238. doi: 10.1097/COC.0000000000000810.
Trastuzumab is used as an agent against human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (AGC). The aim of this study was to determine how HER2 gene amplification and neutrophil-to-lymphocyte ratio (NLR) could predict long-term survival in AGC patients that underwent trastuzumab-based chemotherapy.
We retrospectively reviewed medical records of 112 patients between 28 and 91 years old (median of 66 y) with AGC treated with first-line trastuzumab-based chemotherapy. The level of HER2 gene amplification was determined by the HER2/centromere enumerator probe 17 (CEP17) ratio and HER2 gene copy number (GCN). NLR was calculated as the neutrophil count divided by the lymphocyte counts.
Median HER2/CEP17 ratio, HER2 GCN, and NLR values were 2.85, 7.1, and 2.81, respectively. Objective response rate in both high HER2/CEP17 ratio (59.4% vs. 28.1%, P=0.012) and HER2 GCN groups (62.1% vs. 33.3%, P=0.032) was higher than that of each group. High NLR correlated with significantly worse median overall survival (OS) (median OS, 8.2 vs. 18.9 mo, P=0.002) and progression free survival (PFS) (median PFS: 5.1 vs. 8.0 mo, P=0.005). However, median OS and PFS were not significantly different according to HER2/CEP17 ratio or HER2 GCN. In the multivariate analysis, high NLR, Eastern Cooperative Group performance status, and poorly differentiated/signet ring cell type were independent factors for OS.
NLR was a significant predictor of long-term survival in AGC patients treated with first-line trastuzumab-based chemotherapy. Future validation of prospective trials with larger patient populations will be needed.
曲妥珠单抗是一种针对人表皮生长因子受体 2（HER2）阳性晚期胃癌（AGC）的药物。本研究旨在确定 HER2 基因扩增和中性粒细胞与淋巴细胞比值（NLR）如何预测接受曲妥珠单抗为基础的化疗的 AGC 患者的长期生存。
我们回顾性分析了 112 例年龄在 28 至 91 岁（中位年龄 66 岁）接受一线曲妥珠单抗为基础化疗的 AGC 患者的病历。HER2 基因扩增水平通过 HER2/着丝粒计数探针 17（CEP17）比值和 HER2 基因拷贝数（GCN）来确定。NLR 通过中性粒细胞计数除以淋巴细胞计数计算。
中位 HER2/CEP17 比值、HER2 GCN 和 NLR 值分别为 2.85、7.1 和 2.81。高 HER2/CEP17 比值（59.4% vs. 28.1%，P=0.012）和 HER2 GCN 组（62.1% vs. 33.3%，P=0.032）的客观缓解率均高于各亚组。高 NLR 与中位总生存期（OS）（中位 OS，8.2 与 18.9 个月，P=0.002）和无进展生存期（PFS）（中位 PFS：5.1 与 8.0 个月，P=0.005）显著相关更差。然而，根据 HER2/CEP17 比值或 HER2 GCN，中位 OS 和 PFS 无显著差异。在多变量分析中，高 NLR、东部合作肿瘤组表现状态和低分化/印戒细胞型是 OS 的独立因素。
NLR 是接受一线曲妥珠单抗为基础化疗的 AGC 患者长期生存的重要预测因素。需要未来更大患者群体的前瞻性试验验证。
