Heterogeneous HER2 Gene Amplification Impact on Patient Outcome and a Clinically Relevant Definition
Heterogeneous HER2 Gene Amplification Impact on Patient Outcome and a Clinically Relevant Definition
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DOI：
10.1309/ajcp0en6aqmwetzz
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发表时间：
2011-08-01
影响因子：
3.5
通讯作者：
Bartlett, John M. S.
中科院分区：
文献类型：
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作者：
Bartlett, Alastair I.;Starcyznski, Jane;Bartlett, John M. S.
异质性表达或扩增是对HER 2诊断的挑战。一项指南将异质性定义为存在5%至50%的HER 2/CEP 17比值大于2.20的细胞。我们结合TEAM [他莫昔芬vs依西美坦佐剂多中心]病理学研究的数据，对2个病理学实验室的结果中此类细胞的频率及其临床影响进行了稽查。在6，461例符合条件的病例中，754例（11.7%）显示50%或更多的细胞比率超过2.20，这是美国病理学家学会指南中的“扩增”。在这些病例中，2，166例（33.5%）表现出超过5%但低于50%的细胞HER 2/CEP 17比值大于2.20，或“异质扩增”。“当少于30%的细胞表现出超过2.20的比率时，没有观察到预后影响。根据英国指南，所有扩增病例中30%至50%的细胞比率大于2.20，HER 2/CEP 17比率大于2.20的肿瘤细胞百分比不能识别异质性扩增或预后不良的病例。提出了一种改进的鉴别真异源扩增的方法。
Heterogeneous expression or amplification is a challenge to HER2 diagnostics. A guideline defines heterogeneity as the presence of between 5% and 50% cells with HER2/CEP17 ratios of more than 2.20. We audited the frequency of such cells and their clinical impact in the results from 2 pathology laboratories combined with data from the TEAM [Tamoxifen vs Exemestane Adjuvant Multicentre] pathology study. HER2 reports were scanned and the percentages of amplified cells reported.Of 6,461 eligible cases, 754 (11.7%) exhibited 50% or more cells with ratios of more than 2.20, which is "amplified" by College of American Pathologists guidelines. Of the cases, 2,166 (33.5%) exhibited more than 5% but less than 50% of cells with HER2/CEP17 ratios of more than 2.20, or "heterogeneous amplification." No prognostic impact was observed when fewer than 30% of cells exhibited ratios of more than 2.20. All amplified cases with 30% to 50% of cells with ratios more than 2.20 were identified as such by United Kingdom guidelines.The percentage of tumor cells with HER2/CEP17 ratios more than 2.20 does not identify cases with heterogeneous amplification or poor outcome. A modified approach for identification of true heterogeneous amplification is suggested.