Prognostic significance of performing universal HER2 testing in cases of advanced gastric cancer.
BACKGROUND
Trastuzumab significantly improves overall survival (OS) when added to cisplatin and fluoropyrimidine as a treatment for HER2-positive advanced gastric cancers (AGC). The aim of this study was to evaluate the impact of the gradual implementation of HER2 testing on patient prognosis in a national registry of AGC.


METHODS
This Spanish National Cancer Registry includes cases who were consecutively recruited at 28 centers from January 2008 to January 2016. The effect of missing HER2 status was assessed using stratified Cox proportional hazards (PH) regression.


RESULTS
The rate of HER2 testing increased steadily over time, from 58.3 % in 2008 to 92.9 % in 2016. HER2 was positive in 194 tumors (21.3 %). In the stratified Cox PH regression, each 1 % increase in patients who were not tested for HER2 at the institutions was associated with an approximately 0.3 % increase in the risk of death: hazard ratio, 1.0035 (CI 95 %, 1.001-1.005), P = 0.0019. Median OS was significantly lower at institutions with the highest proportions of patients who were not tested for HER2.


CONCLUSIONS
Patients treated at centers that took longer to implement HER2 testing exhibited worse clinical outcomes. The speed of implementation behaves as a quality-of-care indicator. Reviewed guidelines on HER2 testing should be used to achieve this goal in a timely manner.
Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain. palucaji@hotmail.com.
Paula
P
Jiménez-Fonseca
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain.
Alberto
A
Carmona-Bayonas
Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
Maria Luisa
ML
Sánchez Lorenzo
Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain.
Javier Gallego
JG
Plazas
Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain.
Ana
A
Custodio
Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz De Tenerife, Spain.
Raquel
R
Hernández
Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago De Chile, Chile.
Marcelo
M
Garrido
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain.
Teresa
T
García
Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.
Isabel
I
Echavarría
Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain.
Juana María
JM
Cano
Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
Alberto
A
Rodríguez Palomo
Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain.
Monserrat
M
Mangas
Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain.
Ismael
I
Macías Declara
Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas De Gran Canaria, Spain.
Avinash
A
Ramchandani
Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain.
Laura
L
Visa
Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
Antonio
A
Viudez
Medical Oncology Department, Hospital Clínic, Barcelona, Spain.
Elvira
E
Buxó
Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.
Asunción
A
Díaz-Serrano
Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Carlos
C
López
Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain.
Aitor
A
Azkarate
Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Federico
F
Longo
Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain.
Eduardo
E
Castañón
Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain.
Rodrigo
R
Sánchez Bayona
Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain.
Paola
P
Pimentel
Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain.
Maria Luisa
ML
Limón
Medical Oncology Department, Instituto Oncológico Teknon, Barcelona, Spain.
Paula
P
Cerdá
Medical Oncology Department, Complejo Hospitalario de Orense, Ourense, Spain.
Renata
R
Álvarez Llosa
Medical Oncology Department, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain.
Raquel
R
Serrano
Medical Oncology Department, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, Spain.
Maria Pilar Felices
MPF
Lobera
Medical Oncology Department, Hospital Universitario Vall d'Hebron and VHIO-Vall d'Hebron Institute of Oncology, Barcelona, Spain.
María
M
Alsina
Medical Oncology Department, Hospital Universitario Fundación Alcorcon, Madrid, Spain.
Alicia
A
Hurtado Nuño
Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.
Carlos
C
Gómez-Martin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D013030:Spain; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000401:mortality* / Q000473:pathology; D000068878:Trastuzumab / Q000008:administration & dosage
D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
Gastric cancer; HER2 testing; Personalized medicine; Quality of care; Trastuzumab