Clinicopathological Characteristics of Patient with HER2 Over Expressing in Advanced and Metastatic Epithelial Ovarian Carcinomas at NCI Cairo University
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- Category: Vol. 82, September 2014
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Clinicopathological Characteristics of Patient with HER2 Over Expressing in Advanced and Metastatic Epithelial Ovarian Carcinomas at NCI Cairo University, ALFRED ELIAS, YASSER SALLAM, HANAN SHAFIK and NAYERA A. ABDELHAMID
Abstract
Introduction: Ovarian cancer is the second most common Gynecological malignancy and the leading cause of death from a Gynecological Cancer. There are 204,000 new cases of ovarian Cancer per year worldwide, including about 43,000 cases in Europe and 22,000 in the U.S. Most women present with advanced disease with little prospect for cure. The current standard of care consists of the combination of radical Surgery and platinum-based Chemotherapy. There have been some advances in surgical and Chemotherapeutic strategies, but these approaches have led to small improvements in outcome.
There remains a significant risk for recurrence and resis-tance to Therapy and therefore there is a need to improve upon the current treatment options. Potential strategies for improving outcome in ovarian Cancer include the inhibition of signal transduction pathways and targeting DNA repair.
In advanced disease, overexpression of HER2 has been associated with decreased median survival & failure to respond to Chemotherapy.
Aim of Work: The aim of the current study was to determine the proportion of patients with advanced and metastatic epithelial ovarian Cancer whose tumors were HER2 positive and effect of this on the disease free Survival and Overall Survival of patients.
Patients and Methods: This retrospective study analysis aims at studying the Immunohistochemical expression of HER2 in eligible patients with advanced and metastatic epithelial ovarian cancer at NCI, Cairo University, over a period of five years. to evaluate the Disease Free Survival (DFS) and Overall Survival (OS) of patients. The different Clinicopathological aspects of HER2 overexpressing epithelial ovarian tumor at NCI, Cairo University, and estimation of the disease outcome.
Specimens of 31 patients were available; Immunohis-tochemical studies were performed on paraffin-embedded material with antibodies raised against HER-2 antigens. Only those who had +++ HER2 (Overexpressing) were considered positive for HER2. This was assessed using conventional slides from both primary tumors and metastases and applying reference HER2 screening algorithm for breast tumors, to discriminate equivocal and heterogeneous staining.
Results: Twenty seven patients (87%) were HER2 negative (score 0,+1,+2) while 4 patients (13%) were positive (score+3). Among patients with negative HER2, 52% had serous adeno-carcinoma, 30% had mucinous adenocarcinoma while 19% had other epithelial carcinomas, In patients overexpressing HER2, 25% had serous adenocarcinoma and 75% had muci-nous adenocarcinoma.
Among patients with negative HER2, 13 patients (48%) showed CR, 7 patients (26%) showed PR, and 4 patients (15%) showed SD while 3 patients (11%) showed DP. On the other hand, for patients with HER2 overexpression, 1 patient (25%) showed CR, 1 patient (25%) showed PR, 1 patient (25%) showed DP and one more patients (25%) was not evaluated.
At the end of the follow-up period among patients with negative results 25 patients (92.6%) developed recurrence. All patients with positive HER2 marker and who reached CR developed recurrence. There was a statistically significant difference (p=0.000) between HER2 negative and positive patients as regard DFS.
Among patients with negative results, 11 % of patients survived 5 years. There was a statistically significant difference (p=0.0000) between HER2 negative and positive patients as regard OS.
Conclusion: Among patients with advanced and metastatic epithelial ovarian carcinomas, at NCI Cairo University, HER2 overexpression carries significantly worse prognostic impact on DFS and OS.