The Expression Of HER-2 And Its Clinical Significance In Serous Adenocarcinoma And Carcinoma Of Endometrium

Research backgroundCarcinoma of endometrium is a common gynecologic malignant tumor,taking up 20%to 30%of female genital carcinoma,and more than 3/4 of that is endometrial adenocarnoma.Viewed from the point of etiology,it belongs to ?-type and is relative with the stimulation of no antagonistic estrogen,which has a preferable prognosis.Serious ademocarcinoma is an unusual histologic subtype of endometrial adenocarcinoma,belonging to specific cell type and ?-type from the point of etiology.It has high malignancy and poor prognosis.Its recurrence rate in early phase is about 20%to 60%,and the five-year survival rate in I phase and ? phase is 35%to 50%,while in ? phase and IV phase is 0%to 15%,The preferred therapy is surgical treatment and supplementary radiotherapy and chemotherapy according to postoperative pathology.Recently there is no other therapy which can significantly improve the curative effect.Human epidermal growth factor receptor 2/neu,HER-2/neu,also called c-erbB-2 gene or P185,is a member of epidermal growth factor receptor.A number of studies suggest that the overexpression of HER-2/neu has significant correlation with cell transformation,tumor formation,tumor metastasis,drug resistance and unfavourable prognosis.Recently,Trastuzumab,as the targeted drug targeting at HER-2/neu has been approved by FDA to cure the HER2-positive breast carcinoma and gastric carcinoma and has achieved a satisfying effect.Many studies find out that HER-2/neu is also overexpressed in SA patients,so the research on HER-2 expression in SA tissue and relative targeted therapy feasibility has beome a hot topic.At the same timethe detection methods remain controversial.Whether IHC and FISH normally used for breast carcinoma are also suitable for SA patients is still to be studied further.This research chose these two methods to detect HER-2 in SA and endometrial adenocarcinoma to explore its expression and the relationship between it and clinicopathologic features and prognosis,as well as the consistency of the two methods.Data and methods51 patients diagnosed with endometrial serous ademocarcinoma in ZHEJIANG Cancer Hospital between Jan.2002 to Dec.2012 were detected by the method of Immunohistochemisty(IHC)to find out their expression of HER-2 and analyze their relationship with clinicopathologic features and prognosis.Result1.IHC revealed that among 51 cases of SA,11 patients had positive HER-2 expression(21.6%),while among all the 225 cases of endometrial adenocarcinoma,36 patients had postive HER-2 expression(16%).Although the latter is lower,the difference has no statistical significance by the further statistical analysis(p>0.05).2.The univariate analysis of SA patients indicated that positive expression of HER-2,surgery remains,neoplasm staging and vessel carcinoma embolus were significantly associated with worse prognosis(p<0.05).While the multivariate analysis showed that only positive expression of HER-2 was independent risk factor for prognosis.(p<0.05).3.The univariate analysis of endometrial adenocarcinoma patients indicated that neoplasm staging,vessel carcinoma embolus,lymphatic metastasis and differentiation degree were risk factors for prognosis.While the multivariate analysis showed that neoplasm staging was the independent risk factor for prognosis.4.FISH revealed that 7 patients in 51 cases of SA had positive amplification(13.7%).In all 51 cases,78.4%had HER-2 negative expression(40/51),with 1 case HER-2 amplification positive.The coincidence rate is 97.5%(39/40);11.76%had(+)HER-2 positive expression(6/51),with 1 case HER-2 amplification positive.The coincidence rate is 16.67%(1/6).9.8%had(+++)HER-2 positive expression(5/51),with 5 cases HER-2 amplification positive.The coincidence rate is 100%(5/5).Kappa test confirms that it has good consistency of the two methods,i.e.IHC and FISH.Conclusion1.The expression of HER-2/neu in SA is higher than that in endometrial adenocarcinoma,but there is no significant difference.2.The patients of SA with positive HER-2 expression are older,with high rate of single pathological tissue and poor prognosis.While the positive HER-2 expression in endometrial adenocarcinoma has little relation to prognosis.