免疫组织化学法检测胃癌活检和手术标本HER-2的一致性探讨

发布时间：2018-06-09 04:48

本文选题：HER-2 + 活检　；参考：《上海交通大学》2015年硕士论文

【摘要】：背景:胃癌是危害人类健康的常见恶性肿瘤,我国是胃癌高发地区,新发病例数占世界总数大于40%,其中大部分患者发现时已处于中、晚期,给临床治疗带来很大的困难。曲拓珠单抗为其中一些HER-2阳性的患者带来了新的希望。研究表明,活检标本与手术标本HER-2表达有一定差异。对于无法手术的患者,通过胃镜活检准确地评估HER-2的表达情况就尤为重要。目的:探讨免疫组织化学法在检测胃镜活检标本中HER-2的表达情况,及与手术标本的符合情况。方法:322例胃镜活检标本和390例胃癌手术标本(其中同一患者同时有两种标本的病例101例)入选本研究,所有胃癌标本均石蜡包埋,连续切片,HE染色和HER-2免疫组织化学染色。统计活检与手术切除标本HER-2的表达情况,然后通过卡方检验统计方法,分析胃癌手术切除标本中,肿瘤部位、组织学类型、淋巴结转移与HER-2过表达的关系。最后,以手术切除标本HER-2表达情况为金标准,分析活检标本与手术切除标本的HER-2表达的一致性。结果:1.活检标本HER-2阳性率11.5%(37/322),15.8%的病例2+(51/322),手术标本HER-2阳性率4.4%(17/390),10.0%的病例2+(39/390);2.HER-2表达与胃癌发生部位有关:HER-2的表达率远端胃(胃窦、胃角和幽门,2+或3+,10.1%),中段胃(胃体,2+或3+,19.9%),近端胃(贲门和胃底2+或3+,24%)表达率逐渐增强,具有统计学差异(P=0.014);3.HER-2表达与胃癌组织学类型有关:分化型胃癌(乳头状或管状腺癌)HER-2的表达率(2+和3+,28.7%)明显高于差分化型(低分化腺癌、印戒细胞癌、粘液腺癌、未分化癌)的表达率(2+和3+,9.0%),具有显著统计学差异(P0.001);4.HER-2表达与淋巴结转移无关:不同N分期HER-2过表达率(2+及3+表达率):N0 16.3%,N1 12.3%,N2 17.8%,N3a 14.2%,N3b 5.2%。5.活检标本与手术标本HER-2表达的总体一致为75.2%(76/101),其中活检结果判定偏高的有22例,偏低的有3例;将HER-2 2+和3+认为阳性,其余阴性,则敏感性为88.5%,特异性为76.5%。结论:1.HER-2的过表达与胃癌的部位、组织学类型相关,与淋巴结转移无关;2.对于无法手术的患者,胃镜活检标本HER-2的免疫组化检测是一种可行的筛查方法,同时为了提高活检的准确率,要做到以下几点:胃镜取材保存要规范;判断困难时应该选择较低的值;现行的To GA的判断标准在实际应用中仍需要结合实际情况。
[Abstract]:Background: gastric cancer is a common malignant tumor harmful to human health. China is a high incidence area of gastric cancer. The new cases account for more than 40% of the world. Most of the patients were found in the middle and late stage, which brought great difficulties to clinical treatment. Qu Tuozhu McAb offers new hope for some of the HER-2 positive patients. The expression of HER-2 in biopsy specimens was different from that in surgical specimens. It is important to accurately assess the expression of HER-2 by gastroscopic biopsy in patients who cannot be operated on. Objective: to investigate the expression of HER-2 in gastroscopic biopsy specimens by immunohistochemical method and its coincidence with surgical specimens. Methods 322 specimens of gastroscopy biopsy and 390 cases of gastric cancer were included in this study. All gastric cancer specimens were paraffin embedded, serial sections were stained with HE and HER-2 immunohistochemical staining. The expression of HER-2 in biopsy and surgical specimens was analyzed. The relationship between HER-2 overexpression and tumor location, histological type, lymph node metastasis and HER-2 expression was analyzed by chi-square test. Finally, with the expression of HER-2 in surgical specimens as the gold standard, the consistency of HER-2 expression between biopsy specimens and surgical specimens was analyzed. The result is 1: 1. The positive rate of HER-2 in biopsy specimens was 11.50.The positive rate of HER-2 was 15.8% of the cases, and the positive rate of HER-2 was 4.417 / 390,10.0%. 2. The expression of HER-2 was related to the location of gastric cancer. 2. The expression rate of HER-2 in distal stomach (antrum) was related to the location of gastric cancer. The expression rate of gastric horn and pylorus 2 or 3 + 10. 1 was gradually increased in the middle part of stomach (stomach body 2 or 3) and proximal stomach (cardia and fundus of stomach 2 or 3). The expression of HER-2 in differentiated gastric carcinoma (papillary or tubular adenocarcinoma) was significantly higher than that in poorly differentiated carcinoma (poorly differentiated adenocarcinoma, signet-ring cell carcinoma, mucinous adenocarcinoma), and the expression of HER-2 in differentiated gastric carcinoma (papillary or tubular adenocarcinoma) was significantly higher than that in poorly differentiated carcinoma (poorly differentiated adenocarcinoma, signet ring cell carcinoma, mucinous adenocarcinoma). The expression rate of HER-2 was not related to lymph node metastasis: the overexpression rate of HER-2 in different N stages and the expression rate of N0 16.3N 1 12.3N 2 17.8N 3a 14.2b 5.2n 5. 5 were higher than that of the control group (P 0.001). The expression rate of HER-2 was not related to lymph node metastasis, and the expression rate of HER-2 was significantly higher than that of N stage (P 0.001). 4. HER-2 expression was not related to lymph node metastasis. The overall consistency of HER-2 expression between biopsy specimens and surgical specimens was 75.2% / 101%, among which 22 cases were diagnosed as high and 3 cases as low, and the sensitivity of HER-2 2 and HER-2 3 was 88.5g / 101g, and the specificity was 76.5g when HER-2 2 and 3 were considered positive and negative. Conclusion 1. The overexpression of HER-2 is related to the location and histological type of gastric cancer, but not to lymph node metastasis. For the patients who can not be operated on, the immunohistochemical detection of HER-2 is a feasible screening method. At the same time, in order to improve the accuracy of biopsy, the following points should be achieved: the preservation of gastroscopic materials should be standardized; When it is difficult to judge, the lower value should be chosen, and the current criterion of to GA should be combined with the actual situation in practice.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2

【相似文献】