title: The prognostic impact of epidermal growth factor receptor in patients with metastatic gastric cancer.
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.
authors.affiliation: Department of Hematology and Oncology, Institute of clinical research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt am Main, Germany. atmaca.akin@khnw.de
authors.forename: Akin
authors.initials: A
authors.lastname: Atmaca
authors.forename: Dominique
authors.initials: D
authors.lastname: Werner
authors.forename: Claudia
authors.initials: C
authors.lastname: Pauligk
authors.forename: Kristina
authors.initials: K
authors.lastname: Steinmetz
authors.forename: Ralph
authors.initials: R
authors.lastname: Wirtz
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Altmannsberger
authors.forename: Elke
authors.initials: E
authors.lastname: Jäger
authors.forename: Salah-Eddin
authors.initials: SE
authors.lastname: Al-Batran
mesh_terms: D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism*; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000235:genetics / Q000378:metabolism*; D004943:Esophagogastric Junction / Q000201:enzymology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D013274:Stomach Neoplasms / Q000201:enzymology* / Q000235:genetics / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; D012333:RNA, Messenger; C512478:EGFR protein, human; D066246:ErbB Receptors