Korean J Radiol.  2017 Oct;18(5):809-820. 10.3348/kjr.2017.18.5.809.

Human Epidermal Growth Factor Receptor 2 Expression in Unresectable Gastric Cancers: Relationship with CT Characteristics

• Lee JS
• Kim SH
• Im SA
• Kim MA
• Han JK

• KMID: 2427217
• DOI: http://doi.org/10.3348/kjr.2017.18.5.809

Abstract

OBJECTIVE
To retrospectively analyze the qualitative CT features that correlate with human epidermal growth factor receptor 2 (HER2)-expression in pathologically-proven gastric cancers.
MATERIALS AND METHODS
A total of 181 patients with pathologically-proven unresectable gastric cancers with HER2-expression (HER2-positive [n = 32] and negative [n = 149]) were included. CT features of primary gastric and metastatic tumors were reviewed. The prevalence of each CT finding was compared in both groups. Thereafter, binary logistic regression determined the most significant differential CT features. Clinical outcomes were compared using Kaplan-Meier method.
RESULTS
HER2-postive cancers showed lower clinical T stage (21.9% vs. 8.1%; p = 0.015), hyperattenuation on portal phase (62.5% vs. 30.9%; p = 0.003), and was more frequently metastasized to the liver (62.5% vs. 32.2%; p = 0.001), than HER2-negative cancers. On binary regression analysis, hyperattenuation of the tumor (odds ratio [OR], 4.68; p < 0.001) and hepatic metastasis (OR, 4.43; p = 0.001) were significant independent factors that predict HER2-positive cancers. Median survival of HER2-positive cancers (13.7 months) was significantly longer than HER2-negative cancers (9.6 months) (p = 0.035).
CONCLUSION
HER2-positive gastric cancers show less-advanced T stage, hyperattenuation on the portal phase, and frequently metastasize to the liver, as compared to HER2-negative cancers.

Keyword

Stomach; Cancer; HER2 status; CT

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Kaplan-Meier Estimate
Liver Neoplasms/secondary
Logistic Models
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Odds Ratio
Receptor, ErbB-2/*metabolism
Retrospective Studies
Stomach Neoplasms/diagnostic imaging/mortality/*pathology
Tomography, X-Ray Computed
Young Adult
Receptor, ErbB-2

Figure

• 

  Fig. 1 Flow chart of patient selection process HER2 = human epidermal growth factor receptor 2

• 

  Fig. 2 Kaplan-Meier survival curves comparing survival probability among HER2 (+) cancers treated with trastuzumab (n = 21), and HER2 (+) (n = 11) and HER2 (-) cancers (n = 149) treated with cytotoxic agents alone. HER2 (+) = HER2-positive, HER2 (-) = HER2-negative

• 

  Fig. 3 63-year-old man with metastatic HER2-positive gastric cancer. On axial CT scans obtained at arterial (A) and portal (B) phases, focal wall thickening (arrows) is demonstrated at anterior wall of gastric angle. This lesion shows hyperattenuation on both arterial and portal phases. There was no perigastric infiltration around lesion, indicating that T stage of gastric cancer is less than or equal to cT3. Note multiple hypervascular metastases (arrowheads) in right lobe of liver. cT = clinical T

• 

  Fig. 4 74-year-old man with metastatic HER2-negative gastric cancer. A, B. On axial CT scans obtained at arterial (A) and portal (B) phases, extensive ulceroinfiltrative mass (arrows) was seen at lesser curvature side of gastric high body. This lesion shows hypoattenuation on both arterial and portal phases. There was extensive perigastric infiltration around lesion, indicating that T stage of gastric cancer is at least cT4a. Also, large amount of malignant ascites (*) in abdominal and pelvic cavity was observed. C. Coronal CT image obtained at portal phase demonstrates segmental enhancing wall thickening of left distal ureter (arrow) and left hydronephrosis (*), suggesting periureteral metastasis.

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