Relationship between serum CEA and HER- 2 receptor expression in Gastric Carcinoma

Mithun Kumar Roy; Salma Akhter; Muhammad Saiedullah; Mohammad Abul Mohsin; Mohammad Moniruzzaman; Abdul Khaleque Akond

Volume : VIII, Issue : I, January - 2019

Relationship between serum CEA and HER- 2 receptor expression in Gastric Carcinoma

Mithun Kumar Roy, Salma Akhter, Muhammad Saiedullah, Mohammad Abul Mohsin, Mohammad Moniruzzaman, Abdul Khaleque Akond

Abstract :

Background:Gastric cancer (GC) is considered as one of the leading causes of cancer associated mortality. Carcinoemyonic antigen (CEA) and Human epidermal growth factor receptor- 2 (HER-2) gene expressions are routinely used as diagnostic and prognostic tools in GC patients. However, the relationship between serum CEA and tissue HER-2 gene expression is unknown. Aims and objectives:The aim of this study was to evaluate the agreement between serum CEA level and HER-2/ neu gene expression in gastric cancer in Bangladeshi population. Materials and Methods: In this cross-sectional observational study, total 75 suspected subjects were included: 50 subjects with GC and 25 subjects without GC according to inclusion-exclusion criteria. Blood samples were collected in EDTAcontaining tube. Serum was separated and preserved at -250 C for further analysis. Biopsy specimens were collected in 10% phosphate buffered formalin and later on paraffin embedded. HER-2 expression studied by Immunohistochemistry (IHC) using Herceptest kit.Serum CEA was determined by Enzyme Linked Immunosorbent Assay (ELISA). Histopathological analysis was carried out by HE stain and tumor gradation done. Data were expressed as mean � SD, number (percent).Results of CEA, HER-2 were ranked as negative or positive. Results: Among the cases, well differentiated adenocarcinomas are the most prevalent (48%) followed by moderately (38%) and poorly differentiated adenocarcinoma (12%) and chronic gastritis (84%) was common among the controls. All the control subjects were negative for HER-2 expression and serum CEA. Among the cases, 54% were positive for HER-2 expression and 46% were positive for serum CEA. CEA and HER-2 collectively classify 68% of the subjects correctly. Spearman�s rank correlation coefficient (ρ) between serum CEA and HER-2 expression was 0.127 (p=0.3787) among the cases and inter-rater agreement (κ) between CEA and HER-2 among the total patients was 0.342. The area under the receiver operating characteristic curve (AUC) was 0.730 (95% CI: 0.615 to 0.825) for CEA and 0.770 (95% CI: 0.658 to 0.859) against Immunohistochemical techniques (IHT) classification. The sensitivity and specificity were 46% and 100% for CEA and 54% and 100% for HER-2. Pairwise comparison between CEA and HER-2 classification against GC showed that the difference between areas was 0.0400 (95% CI: -0.0522 to 0.1320) and it was not significant (p=0.395). Conclusion: It may be concluded that a) both serum CEA and tissue HER-2 expression have poor sensitivity regarding diagnostic importance in subjects with confirmed Histopathological diagnosis of gastric cancer.However, HER-2 expression has little higher sensitivity (HER-2 54% vs. CEA 46%) as compared to serum CEA level b) weak correlation or to fair concordance exists between serum CEA and HER-2 expression and c) collective use of CEA level and HER-2 expression may provide better diagnostic outcome.