Trastuzumab significantly improves survival in resectable HER-2 positive gastric cancer: A retrospective study

Gastric cancer (GC), with a five-year survival rate of approximately 20%, frequently displays aggressive behavior when HER-2 is overexpressed. While trastuzumab, a monoclonal antibody against human epidermal growth factor receptor-2 (HER-2), has improved outcomes in advanced GC, its effect in resectable disease is less studied.

This retrospective study included patients who underwent total gastrectomy with D2 lymph node dissection between 2016 and 2021. Among 180 patients, HER-2 status was determined for 97 cases. Of these, 20 HER-2 positive patients received trastuzumab-containing therapies. A control group of 40 HER-2 negative patients was randomly selected. Overall survival (OS) was compared between groups. Univariate and multivariate analyses were used to identify prognostic factors.

Sixty patients with a median follow-up of 29.5 months were analyzed. HER-2 positivity was associated with significantly improved OS (p=0.038). Univariate analyses revealed that HER-2 positivity (p=0.047), younger age (p=0.001), advanced tumor stage (p<0.001), and larger tumor size (p=0.010) were significantly related to OS. In the multivariate model, advanced tumor stage [hazard ratio (HR)=3.634, p=0.001] and younger age (HR=0.213, p<0.001) remained independent predictors of worse survival, while HER-2 positivity and tumor size lost their significance. Tumor subtype and location did not significantly influence OS.

The findings suggest that trastuzumab-containing treatment strategies can markedly improve survival in resectable HER-2 positive GC. Routine assessment of HER-2 status and integration of targeted therapies may enhance patient outcomes. In addition, advanced stage and younger age emerged as key prognostic factors.