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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。HER2的阳性表达提示
Objective To evaluate the clinical value of HER2 expression in patients with lymph node-negative breast cancer and its correlation with prognosis. Methods The related literatures were retrieved by computer. After quality evaluation, the literatures were screened by inclusion and exclusion criteria. Meta analysis was performed by using Excel and Revman4.2, and the stratified analysis was performed according to the detection method and the postoperative adjuvant therapy. Results Fifty-six meta-analyzes of HER2 positive rate were included in the meta-analysis. The positive rate of HER2 was 23.14% (19.54%, 26.73%). The positive rate of immunohistochemistry was 23.13% (19.49%, 26.77% The positive rate of hybridization (FISH) test was 20.90% [15.54%, 26.25%]. Meta-analysis of the association between HER2 expression and prognosis was included in 7 studies. The relative risk-free (RR) values of DFS in patients with node-negative breast cancer were 1.38 [1.07,1.80], overall survival (OS) The combined RR was 1.58 [1.16,2.14], HER2 positive expression had independent negative prognostic value (P <0.05). Stratified analysis based on the detection method also had negative prognostic value: the combined RR of DFS / OS and immunohistochemistry was 1.16 / 1.37 and 1.98 / 2.33 respectively in FISH group. According to the stratified analysis of whether receiving postoperative adjuvant therapy, HER2-positive patients with no treatment group received DFS / OS, and the prognosis of patients with OS did not have prognostic value. The DFS / OS patients without adjuvant therapy group RR values were 1.46 / 1.93, the treatment group OS combined RR value of 1.25. Conclusion The positive rate of HER2 in 23.14% of patients with lymph node-negative breast cancer provided a good clinical application prospect for targeted therapy. The positive expression of HER2 suggests