Abstract
Objective: HER-2/neu status in gastric carcinomas (GCs) has not been studied before in the Egyptian population. Materials and Methods: Seventy-three GCs were evaluated for the expression of HER-2/neu and Ki-67 using immunohistochemistry (IHC). Fluorescence in situ Hybridization (FISH) was done for HER2/neu IHC score 2+ cases. Results: Out of the 73 gastric carcinomas, 23 (31.5%) were score 0, 17 (23.3%) were score 1+, 23 (31.5%) were score 2+, and 10 (13.7%) were score 3+. FISH analysis revealed that the HER-2/neu gene was amplified in 11 out of the 23 cases (47.8%) scored 2+ by IHC. Therefore, the overall HER-2/neu positivity rate was 28.8% and it was significantly associated with higher T-stage and lymphovascular invasion (LVI). The Ki-67 expression rate ranged between 10% and 100%, with 84.9% of the cases (n = 62) featuring high Ki-67 scores. High Ki-67 score was significantly associated with male sex, tumor grade, and number of positive nodes. HER-2/neu protein expression correlated significantly with Ki-67 score. Twenty tumors showed combined HER-2/neu positivity and high Ki-67 score and were significantly associated with higher T-stage and occurrence of LVI, implying a more aggressive behavior. Conclusions: The rate of HER-2/neu positive GCs in our series simulates universal rates, thereby mandating routine evaluation of HER-2/neu status in all GCs submitted to our laboratory to benefit from trastuzumab therapy. Further studies on a larger number of GCs are required to prove that the concurrent HER-2/neu positivity and high Ki-67 score are markers of worse prognosis.
Highlights
MethodsThis study was approved by Alexandria University, Faculty of Medicine Research Ethics Committee
Protein overexpression without amplification was previously reported by Lemoine et al [18], and Kameda et al [19], which indicates that gene amplification may not be the primary mechanism by which the HER2/neu protein is overexpressed in gastric carcinomas (GCs)
We report a rate of HER-2/neu positive GCs of 28.8%, a value close to that reported universally
Summary
This study was approved by Alexandria University, Faculty of Medicine Research Ethics Committee. Seventy-three cases of gastrectomy (whether total or partial) for carcinomas were retrieved retrospectively from the archives of the Pathology department between January 2009 and December 2013. Cases were consecutively accrued with exclusion of patients who received neoadjuvant chemotherapy or radiotherapy and those for whom complete clinical information was lacking. Data about age and sex of the patients, anatomical site of the tumors, lymph node status as well as details of gross examination were obtained from the clinical sheets and pathology reports. All microscopic slides of each case were reviewed and the most representative section with the maximum tumor bulk was selected for immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) analysis. The corresponding tissue block was retrieved and 5 micron sections were cut from each block, one for Hematoxylin and Eosin staining and 3 sections on coated slides for IHC and FISH
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