胃癌患者循环肿瘤细胞HER2的动态检测及其临床意义

目的:探讨胃癌循环肿瘤细胞(circulating tumor cell,CTC)HER2的表达及动态情况,为胃癌Herceptin治疗提供临床依据。方法:通过循环肿瘤细胞检测方法（微流控芯片分离技术）及免疫组织化学方法（EnVision法），检测86例胃癌血液中术前一周、手术后及化疗后三次CTC-HER2表达情况，分析与原组织学HER2表达状况的关系。结果:86例胃癌术前、手术后及化疗后CTC-HER2阳性检出率分别为46.51%（40/86）、15.12%（13/86）、11.63%（10/86），术前与术后及化疗后比较，差异有统计学意义（P＜0.05）；三次总检测阳性率为61.63%（53/86）；组织学HER2阴性CTC-HER2阳性检出率29.17%（14/48），与组织学比较，差异有统计学意义（P＜0.05）；术前基线检测CTC-HER2与组织学一致性高92.11%（35/38）。结论:术前基线检测CTC-HER2尤为重要，多次动态检测CTC-HER2可以增加HER2阳性概率，可为胃癌组织学HER2阴性的患者提供靶向治疗机会。

Dynamic detection of circulating tumor cells HER2 in patients with gastric cancer and its clinical significance

Objective:To investigate the expression and dynamics of HER2 in circulating tumor cell(CTC) of gastric cancer,and provide clinical basis of the treatment of Herceptin in gastric cancer.Methods:The circulating tumor cell detection method(microfluidic chip separation technology) and immunohistochemical method(EnVision method) were used to detect the expression of CTC-HER2 in the blood of 86 patients with gastric cancer at one week before surgery,after surgery and after chemotherapy,and analyze their relationship with the expression of HER2 in histology.Results:The positive rates of CTC-HER2 were 46.51%(40/86),15.12%(13/86) and 11.63%(10/86) in 86 cases of gastric cancer before operation,after operation and after chemotherapy,respectively.The difference was statistically significant between the positive rate before operation and that after operation and after chemotherapy(P<0.05).The total positive rate of three tests was 61.63%(53/86).In histology,the positive detection rate of CTC-HER2 in HER2 negative patients was 29.17%（14/48）.Compared with histology,the difference was statistically significant(P<0.05).In the baseline test before operation,the consistency of CTC-HER2 value with that in histology was as high as 92.11%(35/38).Conclusion:Preoperative baseline detection of CTC-HER2 is particularly important.Multiple dynamic detection of CTC-HER2 can increase the positive rate of HER-2 and provide targeted treatment opportunities for gastric cancer patients whose HER2 is negative in histology.