摘要
目的 探讨尿路上皮癌患者人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)表达情况与临床病理特征之间的关系.方法 收集2019年1月至2023年1月天津医科大学第二医院接受手术治疗的836例尿路上皮癌患者资料,通过免疫组化检测HER2、细胞角蛋白20(cytokeratin 20,CK20)、肿瘤蛋白53(tumor protein 53,P53)、肿瘤增殖抗原Ki67的表达情况.HER2判读标准参考《中国尿路上皮癌人表皮生长因子受体2检测临床病理专家共识》,HER2(3+)定义为HER2阳性.分析HER2表达与临床病理特征之间的关系.结果 本研究共纳入836例患者,中位年龄70(48～96)岁,尿路上皮癌伴组织学变异率23.09％(193例),HER2总体阳性率30.98％(259例).不同组织学变异类型间HER2表达差异有统计学意义(P＜0.05).其中,微乳头样变HER2阳性比例最高(19/31,61.29％),其余依次为浆细胞样变(3/5,60.00％)、透明细胞样变(1/2,50.00％)、伴腺样分化(16/39,41.03％),肉瘤样癌中无HER2阳性患者(0/4).HER2表达与患者性别、肿瘤部位、肿瘤分级、组织学变异类型、Ki67表达水平、P53表达水平及CK20表达水平有关,差异有统计学意义(P＜0.05).二分类多因素logistic回归分析结果显示,肿瘤位于膀胱、肿瘤高级别、伴有原位癌、CK20异常是HER2阳性的独立危险因素(P＜0.05).结论 尿路上皮癌HER2表达情况与肿瘤级别、肿瘤发生部位、CK20表达、伴有原位癌密切相关,但与肿瘤T分期、淋巴血管侵犯未见明显相关性.不同类型组织学变异之间HER2表达差异有统计学意义.
Abstract
Objective To investigate the relationship between human epidermal growth factor receptor 2(HER2)expression and clinical pathological characteristics in patients with urothelial carcinoma.Methods Data from 836 patients with urothelial carcinoma who underwent surgical treatment in the Second Hospital of Tianjin Medical University from January 2019 to January 2023 were collected.HER2,cytokeratin 20(CK20),tumor protein 53(P53),and Ki67 expression were assessed using immunohistochemistry.HER2 interpretation criteria were based on the clinical-pathological expert consensus on HER2 testing in urothelial carcinoma in China,with HER2(3+)defined as HER2 positive.The relationship between HER2 expression and clinical pathological characteristics was analyzed.Results This study included 836 patients with a median age of 70(range 48-96)years.Urothelial carcinoma with histological variants 23.09％(193 cases).The overall HER2 positivity rate was 30.98％(259 cases).HER2 expression varied significantly among different histological variants(P＜0.05).Among them,micropapillary variant had the highest HER2 positivity rate(19/31,61.29％),followed by plasmacytoid variant(3/5,60.00％),clear-cell variant(1/2,50.00％),and glandular differentiation(16/39,41.03％),while no HER2 positivity was observed in sarcomatoid carcinoma(0/4).HER2 expression was associated with patient gender,tumor location,tumor grade,histological category,Ki67 status,P53 status,and CK20 status the difference was statistically significant(P＜0.05).Binary multivariate logistic regression analysis revealed that tumor located in the bladder,high-grade tumor,concomitant carcinoma in situ,and abnormal CK20 were independent risk factors for HER2 positivity the difference was statistically significant(P＜0.05).Conclusions HER2 expression in urothelial carcinoma is closely related to tumor grade,tumor location,CK20 status,and concomitant carcinoma in situ,but is not correlated with tumor T stage and lymphovascular invasion.Significant differences in HER2 expression levels were observed among different histological variants.
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