RESUMO
AIM: HER2-positive metastatic gastric cancer is still a highly fatal disease despite advances. We aimed to investigate the relationship between HER2/CEP17 ratio and survival in patients with HER2-positive metastatic gastric cancer. METHODS: A total of 99 patients from 8 different centers in Turkey were included in the study. Patients with HER2-positive metastatic gastric cancer and whose HER2/CEP17 ratio was examined were included in the study. Patients were divided into two groups according to HER2/CEP17 values, and survival analysis was performed. RESULTS: The median age was 64 (24-83) years. There were 74 (74.8%) male and 25 (25.2%) female patients. OS in the high HER2/CEP17 ratio group was 21.97 months (95% CI: 16.36-27.58), and in the low ratio group was 16.17 months (95% CI: 10.95-21.38) (p = 0.015). OS was 17.7 months (95% CI: 7.02-28.37) in the high HER2 gene copy number group and 10.13 months (5.55-14.71) in the group with low copy number (p = 0.03). PFS was 10.94 months (95% CI: 7.55-14.33) in the group with high HER2 gene copy number and 7.56 months (4.62-10.49) in the low copy number group (p = 0.06). CONCLUSION: Patients with both high HER2 gene amplification and high HER2/CEP17 ratio had better OS. The PFS of the group with high HER2 gene amplification was also better. To our knowledge, this is the first study in the literature showing that the HER2/CEP17 ratio affects survival in patients with metastatic gastric cancer.
Assuntos
Receptor ErbB-2 , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/genética , Neoplasias Gástricas/metabolismo , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Receptor ErbB-2/metabolismo , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Prognóstico , Taxa de Sobrevida , Turquia/epidemiologia , Cromossomos Humanos Par 17/genética , Hibridização in Situ FluorescenteRESUMO
BACKGROUND: The use of neoadjuvant chemotherapy (NAC) in less aggressive breast cancer (BC) is controversial. OBJECTIVE: To investigate the effect of neoadjuvant chemotherapy in HER2 negative luminal B breast cancer. PATIENTS AND METHODS: Patients between January 2016 and December 2021 were retrospectively evaluated. RESULTS: A total of 128 patients were included in the study. Patients with pathological complete response (pCR) were younger and had higher ki67 levels. Cutoff levels for ki67 based on pCR and ypT status were ≤ 40% and ≤ 35%, respectively. According to pre-NAC magnetic resonance imaging findings, only mastectomy was viable in 90 patients, but after NAC breast-conserving surgery (BCS) was possible in 29 (32%). Moreover, 68.5% became eligible for sentinel lymph node biopsy (SLNB) after NAC. Since SLNB was positive in 45 (54.2%), axillary lymph node dissection (ALND) was performed and the remainder, 38 (31.4%), avoided ALND. CONCLUSION: In patients with Luminal B, HER2(-) BC a low pCR rate should not discourage the use of NAC. The ki67 level is a guide for individualizing treatment. Especially in young patients with high ki67 levels, NAC increases the chance of breast-conserving surgery and may spare patients from ALND.
ANTECEDENTES: El uso de quimioterapia neoadyuvante (QTN) en cáncer de mama (CB) menos agresivo es controversial. OBJETIVO: Investigar el efecto de la quimioterapia neoadyuvante en el cáncer de mama HER2 negativo luminal B. MÉTODO: Se evaluaron retrospectivamente pacientes entre enero de 2016 y diciembre de 2021. RESULTADOS: Se incluyeron 128 pacientes. Los valores de corte para ki67 basados en el estado de respuesta patológica completa y el estadio tumoral tras la quimioterapia neoadyuvante fueron ≤ 40% y ≤ 35%, respectivamente. Según los hallazgos de la resonancia magnética previa a la quimioterapia neoadyuvante, la mastectomía solo fue viable en 90 pacientes, pero después de la quimioterapia neoadyuvante la cirugía conservadora de la mama fue posible en 29 (32%). Además, el 68.5% se volvieron elegibles para biopsia del ganglio linfático centinela después de la quimioterapia neoadyuvante, y se evitó la disección de ganglios linfáticos axilares en 38 pacientes (31.4%). CONCLUSIONES: En las pacientes con cáncer de mama HER2 negativo luminal B, una tasa baja de respuesta patológica completa no debe desalentar el uso de quimioterapia neoadyuvante. En especial en pacientes jóvenes con niveles altos de ki67, la quimioterapia neoadyuvante aumenta la posibilidad de una cirugía conservadora de la mama y puede evitar que las pacientes sufran disección de ganglios linfáticos axilares.