HER2 as a potential biomarker of lymph node metastasis in undifferentiated early gastric cancer

Sanghoon Han,Kyoung Oh Kim,Seungyoon Nam,Yoon Jae Kim,Jungsuk An,Dong Kyun Park,Jung Ho Kim,Jun-Young Yang,Sungjin Park,Jun-Won Chung,Woon Kee Lee,Kwang An Kwon

doi:10.1038/s41598-020-61567-1

Abstract

Human epidermal growth factor receptor 2 (HER2) is implicated in several cancers, including gastric cancer. However, limited data are available regarding its clinical significance in early gastric cancer (EGC). We evaluated the clinical significance of HER2 overexpression in patients with EGC. We retrospectively reviewed 727 patients who underwent surgical treatment for EGC between October 2010 and August 2017. HER2 expression was analysed in 680 EGC cases by immunohistochemistry and classified as negative (0 and 1+), equivocal (2+), or positive [overexpression (3+)]. Among patients with differentiated EGC, the number of patients with HER2 overexpression was not significantly different from that of HER2-negative patients in terms of age, sex, tumour size, location, gross type, depth of invasion, presence of lymphovascular invasion (LVI), and presence of lymph node metastasis (LNM). However, in patients with undifferentiated EGC, HER2 overexpression was significantly correlated with LVI and presence of LNM compared with HER2-negative patients. Multivariate analysis indicated HER2 overexpression as a good predictive marker of LNM in patients with undifferentiated EGC. HER2 expression is associated with LNM in undifferentiated EGC. Therefore, the importance of HER2 overexpression in EGC should not be overlooked, and further studies are needed to identify its clinical significance.

Highlights

Gastric cancer is the fifth most common malignancy worldwide[1]
We analysed the correlation of clinical characteristics according to the degree of Human epidermal growth factor receptor 2 (HER2) expression
Our analysis showed that when HER2 expression increases from ‘negative’ to ‘equivocal’ and further to ‘positive’, the expression patterns were correlated with clinical factors such as age, sex, tumour size, depth of invasion, histology, and lympho-vascular invasion in all early gastric cancer (EGC) patients

Summary

Introduction

Gastric cancer is the fifth most common malignancy worldwide[1]. In Korea, gastric cancer is the second highest in men and fourth highest in women[2]. This screening program recommends upper gastrointestinal (GI) endoscopy or upper GI imaging every 2 years This screening has led to early treatment of gastric cancer and lower mortality[3,4]. As the detection rate of early gastric cancer (EGC) has increased, treatment and prognosis of EGC have become very important. It is very important to confirm the presence of LNM in EGC before endoscopic resection, a non-invasive treatment. Endoscopic resection is frequently performed in patients with EGC classified by expanded criteria at many centres[11]. There have been many studies on various targets that can be practically applied in the diagnostic process[1,16] If these markers are included in criteria to determine the indication for endoscopic treatment, predicting LNM may be more accurate

Methods

Results

Conclusion