Development of a quantitative PCR assay to evaluate HER2 status of Gastric carcinoma in a cohort of Sri Lankan patients

Abstract

INTRODUCTION AND OBJECTIVES: Human epidermal growth factor receptor2(HER2) protein overexpression and/or HER2gene amplification is linked to dismal outcome of Gastric carcinoma(GCa). Immunohistochemistry(IHC) and fluorescence in situ hybridization(FISH) are key-methods to identify patients for HER2 targeted therapy. Drawbacks of both methods warrant novel tests. The study aimed to determine whether quantitative Polymerase Chain Reaction (qPCR) could serve as a supplementary-method to evaluate HER2 status of GCa in a cohort of Sri Lankan patients and investigate correlation between HER2 assessed by different methods and clinic-pathological features. METHOD: Twenty GCa-patients with known IHC-HER2 scores were evaluated. qPCR was performed for HER2gene and Ameloid precursor protein (reference gene) in Formalin fixed paraffin embedded GCa tissue. Threshold values(Ct) were analyzed using Pfaffl-method to detect HER2gene amplification. RESULTS: HER2positivity by IHC(protein) and qPCR(gene) were 20% and 35% respectively. Sensitivity and specificity of qPCR was 67% and 76% respectively and results were reproducible. HER2protein positivity was correlated with Tumour TNM-stage and Lauren-histological types(P<0.05). Positive expression of HER2gene was correlated with depth of tumour invasion, differentiation and Lymph node-status(P<0.05). Diagnostic consistency between IHC and qPCR(κ=0.146) was slightly agreeable(0.01<k<0.20), having 65% concordance. CONCLUSIONS: Discrepancies between HER2 positivity by IHC and qPCR were possibly due to transcription activation by other genes in the absence of HER2 gene amplification and the aberrant form of HER2protein not detected by IHC. Studies also indicate a higher-proportion of IHC negative, but HER2gene amplified GCa by FISH.qPCR may be used as a supplementary-method for detection of HER2status of GCa in local setting.