摘要
目的评价淋巴结阴性乳腺癌患者HER2表达率的临床价值及其与预后的相关性。方法计算机检索相关文献,进行质量评价后按纳入和排除标准筛选文献,采用Excel和Revman4.2进行Meta分析,并按检测方法和是否接受术后辅助治疗进行分层分析。结果纳入56篇研究进行HER2阳性率的Meta分析,合并总阳性率为23.14%[19.54%,26.73%],免疫组织化学检测组合并阳性率为23.13%[19.49%,26.77%],荧光原位杂交(FISH)检测组合并阳性率为20.90%[15.54%,26.25%]。纳入7篇研究进行HER2表达与预后相关性的Meta分析,对淋巴结阴性乳腺癌患者无瘤生存期(DFS)合并相对危险度(RR)值为1.38[1.07,1.80],总生存期(OS)合并RR值为1.58[1.16,2.14],HER2阳性表达均有独立的负性预后价值(P<0.05)。根据检测方法进行分层分析亦有负性预后价值:免疫组织化学组DFS/OS合并RR值分别为1.16/1.37,FISH组DFS/OS合并RR值分别为1.98/2.33。根据是否接受术后辅助治疗进行分层分析,显示HER2阳性对未接受治疗组DFS/OS、接受治疗组OS有预后价值,对接受治疗组DFS缺乏预后价值;未接受辅助治疗组DFS/OS合并RR值分别为1.46/1.93,接受治疗组OS合并RR值为1.25。结论对于淋巴结阴性的乳腺癌患者,23.14%的HER2阳性率为靶向治疗提供了良好的临床应用前景。
Objective To evaluate the clinical value of HER2 overexpression in breast cancer and its prognostic implication in patients with lymph node negative breast carcinoma. Methods The following electronic database were extracted using appropriate inclusive and exclusive standards: Cochrane library、PUBMED、Embase(1984-2003)、OVID、CMCC and CNKI. Excel and RevMan 4.2 were used for statistical analysis. Results Fifty-six articles were extracted to calculate the positive rate of HER2 overexpression. The pooled positive rate was 23.14% [19.54%, 26.73%], with positive immunohistochemistry (IHC) rate of 23.13% [19.49%,26.77%]and positive FISH rate of 20.90% [15.54%,26.25%]. Seven articles were used to evaluate prognostic predication of HER2 expression. It was concluded that in patients with lymph node negative breast carcinoma, HER2 overexpression (both IHC and FISH) independently predicted a poor prognosis based on disease-free survival(DFS) and overall survival (OS) with a P<0.05. For DFS, the pooled RR was 1.38[1.07,1.80] with1.16[1.02,1.31] for IHC and 1.98[1.56,2.52] for FISH. For OS, the pooled RR was 1.58[1.16,2.14] with 1.37[1.14 to 1.64] for IHC and 2.33[1.45 to 3.75] for FISH. HER2 overexpression effectively predicted DFS/OS of patients without adjuvant therapy and OS of patients with the therapy, but not for DFS, with the pooled RR of 1.46[1.02,2.09] and 1.11[0.95,1.31] for DFS, respectively and the pooled RR of 1.93[1.44 to 2.58] and 1.25[1.01,1.56] for OS, respectively. Conclusions In patients with lymph node negative breast carcinoma, the positive rate of HER2 overexpression is 23.14%. HER2 overexpression indicates a poor prognosis and adjuvant therapy after surgery should be recommended.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2005年第3期140-146,共7页
Chinese Journal of Pathology
