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Open Access Research article

The prognostic impact of epidermal growth factor receptor in patients with metastatic gastric cancer

Akin Atmaca1*, Dominique Werner1, Claudia Pauligk1, Kristina Steinmetz1, Ralph Wirtz2, Hans-Michael Altmannsberger3, Elke Jäger1 and Salah-Eddin Al-Batran1

Author affiliations

1 Department of Hematology and Oncology, Institute of clinical research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt am Main, Germany

2 STRATIFYER Molecular Pathology GmbH, Köln, Germany

3 Institute for Pathology, Krankenhaus Nordwest, Frankfurt am Main, Germany

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Citation and License

BMC Cancer 2012, 12:524  doi:10.1186/1471-2407-12-524

Published: 15 November 2012

Abstract

Background

The epidermal growth factor receptor (EGFR) is a potential target of anticancer therapy in gastric cancer. However, its prognostic role in metastatic gastric or gastroesophageal junction (GE) cancer has not been established yet.

Methods

EGFR status was analyzed by immunohistochemistry (IHC) in paraffin-embedded samples from 357 patients who received chemotherapy in 4 first-line trials. Automated RNA extraction from paraffin and RT-quantitative PCR were additionally used to evaluate EGFR mRNA expression in 130 patients.

Results

EGFR protein expression (any grade) and overexpression (3+) were observed in 43% and 11% of patients, respectively. EGFR positivity correlated with intestinal type histology (p = 0.05), but not with other clinicopathologic characteristics. Median follow-up was 18.2 months. Median overall survival (OS) was similar in patients with EGFR positive vs. those with EGFR negative tumors, regardless whether positivity was defined as ≥1+ (10.6 vs. 10.9 months, p = 0.463) or as 3+ (8.6 vs. 10.8 months, p = 0.377). The multivariate analysis indicated that EGFR status is not an independent prognostic factor (hazard ratio 0.85, 0.56 to 1.12, p = 0.247). There were also no significant differences in overall survival when patients were categorized according to median (p = 0.116) or quartile (p = 0.767) distribution of EGFR mRNA gene expression. Similar distributions of progression-free survival according to EGFR status were observed.

Conclusions

Unlike different cancer types where EGFR-positive disease is associated with an adverse prognostic value, EGFR positivity is not prognostic of patient outcome in metastatic gastric or GE cancer.

Keywords:
EGFR; Immunohistochemistry; Gastric cancer; Survival; Prognostic