World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://wjon.elmerpub.com

Original Article

Volume 000, Number 000, April 2025, pages 000-000


Co-expression of HER2/EGFRvIII/CD44 and Claudin 18.2/CD109 as Novel Prognostic Indicators in Stomach Adenocarcinoma

Figures

Figure 1.
Figure 1. The immunohistochemical staining of HER family members, EGFRvIII, CD44, CD109, and CLDN18.2 in whole tumor specimens from patients with stomach adenocarcinoma (× 200 magnification). (a) EGFR 3+ membranous/cytoplasmic, (b) HER2 3+ membranous, (c) HER3 2+/3+ membranous, (d) HER4 1+ nuclear/cytoplasmic, (e) EGFRvIII 2+ cytoplasmic, (f) CD44 3+ membranous, (g) CD109 1+ membranous/cytoplasmic, (h) CLDN18.2 2+/3+ membranous, and (i) CLDN18.2 3+ in normal tissue and 2+ in tumor (arrow). CD44: cluster of differentiation 44; CD109: cluster of differentiation 109; CLDN18.2: claudin 18.2; EGFR: epidermal growth factor receptor; EGFRvIII: epidermal growth factor receptor variant III; HER2: human epidermal growth factor receptor.
Figure 2.
Figure 2. The prognostic significance and the association between the sub-categories of receptor expression and the OS of stomach cancer patients expressing EGFRvIII intensity 1+ (a), CD109 membranous expression (b), CLDN18.2 intensity 3+ (c), HER2/EGFRvIII at cut-off value of ≥ 5% (d), and HER2/EGFRvIII at cut-off value of ≥ 10% (e). A log-rank test value of P ≤ 0.05 was considered statistically significant. CD109: cluster of differentiation 109; CLDN18.2: claudin 18.2; EGFRvIII: epidermal growth factor receptor variant III; HER2: human epidermal growth factor receptor 2; OS: overall survival.
Figure 3.
Figure 3. The prognostic significance and the association between the sub-categories of receptor expression and the OS of stomach cancer patients expressing HER2/EGFRvIII/CD44 at cut-off value of ≥ 5% (a), EGFRvIII/CD44 at cut-off value of ≥ 5% (b), EGFRvIII/CD44/CD109 at cut-off value of ≥ 5% (c), and CD109/CLDN18.2 at a cut-off value of ≥ 20% (d) in patients with stomach cancer. A log-rank test value of P ≤ 0.05 was considered statistically significant. CD44: cluster of differentiation 44; CLDN18.2: claudin 18.2; EGFRvIII: epidermal growth factor receptor variant III; HER2: human epidermal growth factor receptor 2; OS: overall survival.

Tables

Table 1. Patient Clinicopathological Characteristics and Association With Overall Survival Using Kaplan-Meier Analysis and Log-Rank Test in 78 Stomach Tumor Specimens
 
CharacteristicsNumber of patients (%)Overall survival in years (mean ± SE)95% CIP-value
*Statistically significant. CI: confidence interval; SE: standard error.
Age0.369
  < 6012 (15.4)7.0 ± 1.54.0 - 10.0
  ≥ 60
Gender66 (84.6)6.3 ± 0.75.0 - 7.50.277
  Male
Lauren classification55 (70.5)6.9 ± 0.85.3 - 8.50.394
  Intestinal type39 (50.6)6.1 ± 0.84.5 - 7.7
  Diffuse type/mixed type
T-stage38 (44.2)7.2 ± 0.95.3 - 9.10.185
  T1 + T239 (50.0)7.2 ± 0.85.6 - 8.9
  T3 + T4
Grade39 (50.0)5.2 ± 0.73.8 - 6.70.353
  < G322 (28.2)5.6 ± 1.13.4 - 7.7
  G3
Lymph node invasion56 (71.8)6.7 ± 0.75.2 - 8.10.030*
  Absent32 (41.0)8.4 ± 1.86.1 - 10.7
  Present
Lymphatic invasion46 (59.0)5.3 ± 0.74.0 - 6.70.575
  Absent32 (41.0)6.9 ± 0.95.1 - 8.6
  Present
Vascular invasion46 (59.0)6.4 ± 0.94.4 - 8.30.057
  Absent57 (73.1)7.1 ± 0.85.6 - 8.6
  Present
Perineural invasion21 (26.9)4.4 ± 0.82.9 - 5.90.019*
  Absent50 (64.1)7.3 ± 0.85.9 - 8.8
  Present28 (35.9)3.9 ± 0.72.5 - 5.3

 

Table 2. Immunohistochemical Expression/Co-Expression of HER Family Members, EGFRvIII, CD44, CD109, and CLDN18.2
 
Receptor expression
Scoring criteriaWt-EGFRHER2HER3HER4EGFRvIIICD44CD109CLDN18.2
Percentage of positive tumor cells, %
  ≥ 5%10 (12.8)64 (82.1)7 (9.0)26 (33.3)26 (33.3)32 (41.0)47 (60.3)31 (39.7)
  ≥ 10%6 (7.7)60 (76.9)4 (5.1)19 (24.4)17 (21.8)31 (39.7)44 (56.4)24 (30.8)
  ≥ 20%3 (3.8)53 (67.9)2 (2.6)15 (19.2)10 (12.8)24 (34.6)34 (43.6)17 (21.8)
  ≥ 50%1 (1.3)28 (35.9)04 (5.1)7 (9.0)13 (15.7)20 (23.3)13 (16.7)
Intensity
  1+8 (10.3)34 (43.6)4 (5.1)25 (32.1)20 (25.6)14 (17.9)47 (60.3)19 (24.4)
  2+032 (41.0)4 (5.1)1 (1.3)11 (14.1)16 (20.5)1 (1.3)14 (17.9)
  3+2 (2.6)6 (7.7)2 (2.6)0014 (17.9)06 (7.7)
Sub-cellular localization
  Membranous3 (3.8)10 (12.8)5 (6.4)0032 (41.0)17 (19.8)31 (39.7)
  Cytoplasmic10 (12.8)61 (78.2)3 (2.8)17 (21.8)25 (32.1)047 (60.3)0
  Nuclear00022 (28.2)2 (2.6)000
Co-expression
Markers≥ 5% cut-off≥ 10% cut-off≥ 20% cut-off≥ 50% cut-off
CD: cluster of differentiation; CLDN18.2: claudin 18.2; EGFRvIII: epidermal growth factor receptor variant III; HER2: human epidermal growth factor receptor 2; wt: wild-type.
Wt-EGFR/HER27 (9.0)4 (5.1)1 (1.3)0
Wt-EGFR/CD1098 (10.3)6 (7.7)3 (3.8)1 (1.3)
HER2/HER421 (26.9)14 (17.9)11 (14.1)1 (1.3)
HER2/EGFRvIII22 (28.2)12 (15.4)4 (5.1)0
HER2/CD4426 (33.3)21 (26.9)16 (20.5)4 (5.1)
HER2/CD10938 (48.7)34 (43.6)24 (30.8)10 (12.8)
HER2/CLDN18.225 (32.1)19 (24.4)13 (16.7)4 (5.1)
HER2/EGFRvIII/CD449 (11.5)4 (5.1)4 (5.1)0
HER2/EGFRvIII/CD10913 (16.7)5 (6.4)1 (1.3)0
HER2/CD44/CD10920 (25.6)16 (20.5)10 (12.8)3 (3.8)
HER2/CD44/CLDN18.213 (16.7)9 (11.5)3 (3.8)0
HER2/CD44/CD109/CLDN18.212 (15.4)9 (11.5)2 (2.6)0
HER2/ CD109/CLDN18.220 (25.6)16 (20.5)9 (11.5)2 (2.6)
HER4/EGFRvIII7 (9.0)1 (1.3)00
HER4/CD4415 (19.2)8 (10.3)7 (9.0)0
HER4/CD10919 (24.4)16 (20.5)8 (10.3)1 (1.3)
HER4/CLDN18.213 (16.7)8 (10.3)4 (5.1)0
HER4/CD44/CD10911 (14.1)7 (9.0)5 (6.4)0
HER4/CD44/CLDN18.28 (10.3)3 (3.8)00
HER4/CD109/CLDN18.213 (16.7)8 (10.3)3 (3.8)0
HER4/CD44/CD109/CLDN18.28 (10.3)3 (3.6)00
EGFRvIII/CD4410 (12.8)4 (5.1)4 (5.1)1 (1.3)
EGFRvIII/CD10914 (17.9)6 (7.7)2 (2.6)0
EGFRvIII/CLDN18.210 (12.8)2 (2.6)00
EGFRvIII/CD44/CD1098 (10.3)3 (3.8)1 (1.3)0
EGFRvIII/CD109/CLDN18.27 (9.0)2 (2.6)00
CD44/CD10924 (30.8)20 (25.6)13 (16.7)5 (6.4)
CD44/CLDN18.215 (19.2)11 (14.1)3 (3.8)2 (2.6)
CD44/CD109/CLDN18.214 (17.9)10 (12.8)2 (2.6)1 (1.3)
CD109/CLDN18.225 (32.1)21 (26.0)12 (15.4)(6.4)

 

Table 3. Association Between Clinicopathological Characteristics and Protein Expression Using Chi-Square Test (FET)
 
Receptor (sub-categories)Clinicopathological parametersChi-square test (FET)
Number of patients with receptor expression
CD: cluster of differentiation; CLDN18.2: claudin 18.2; EGFRvIII: epidermal growth factor receptor variant III; FET: Fisher’s exact t-test; HER2: human epidermal growth factor receptor 2; wt: wild-type.
Age
< 60≥ 60
HER2/CLDN18.2 (≥ 5%)0250.010 (0.007)
HER2/CLDN18.2 (≥ 10%)0190.033 (0.032)
HER2/CD109/CLDN18.2 (≥ 5%)0200.027 (0.030)
Lauren classification
Intestinal typeDiffuse/mixed type
HER2/CD44/CLDN18.2 (≥ 5%)3100.026 (0.034)
T-stage
T1 + T2T3 + T4
HER2 (intensity 1+)12220.022 (0.039)
EGFRvIII (≥ 5%)6200.0008 (0.002)
EGFRvIII (cytoplasmic)6190.002 (0.003)
EGFRvIII (intensity 1+)5150.010 (0.018)
HER2/HER4 (≥ 5%)1560.022 (0.040)
HER2/EGFRvIII (≥ 5%)6160.012 (0.022)
Vascular invasion
AbsentPresent
Wt-EGFR (≥ 10%)150.001 (0.005)
Wt-EGFR (membranous)030.004 (0.017)
EGFRvIII (cytoplasmic)14110.020 (0.029)
EGFRvIII (intensity 1+)1190.035 (0.044)
Wt-EGFR/CD109 (≥ 5%)350.017 (0.029)
Wt-EGFR/CD109 (≥ 10%)150.001 (0.005)
Lymphatic invasion
AbsentPresent
Wt-EGFR (≥ 5%)0100.005 (0.004)
Wt-EGFR (cytoplasmic)0100.005 (0.004)
Wt-EGFR (intensity 1+)080.013 (0.018)
EGFRvIII (≥ 5%)5210.006 (0.007)
EGFRvIII (cytoplasmic)5200.010 (0.013)
EGFRvIII (intensity 1+)3170.006 (0.008)
Wt-EGFR/HER2 (≥ 5%)070.021 (0.037)
Wt-EGFR/CD109 (≥ 5%)080.013 (0.018)
HER2/EGFRvIII (≥ 5%)4180.010 (0.011)
HER4/EGFRvIII (≥ 5%)070.021 (0.037)
Perineural invasion
AbsentPresent
CLDN18.2 (≥ 20%)7100.026 (0.043)
Grade
< G3G3
HER2 (membranous)730.002 (0.004)
HER2 (intensity 1+)5290.020 (0.024)
CD109 (≥ 10%)17270.020 (0.024)
CD109 (membranous)1070.002 (0.004)
HER2/CD109 (≥ 5%)16220.008 (0.011)
HER2/CD109 (≥ 10%)16180.001 (0.002)

 

Table 4. Association Between Expression of HER Family Members and Overall Survival in Univariate and Multivariate Analysis
 
ExpressionUnivariateMultivariate
Hazard ratio95% CIP-valueHazard ratio95% CIP-value
CD: cluster of differentiation; CI: confidence interval; CLDN18.2: claudin 18.2; EGFRvIII: epidermal growth factor receptor variant III; HER2: human epidermal growth factor receptor 2; NS: non-significant.
EGFRvIII intensity 1+NSNS
CD109 membranous2.041.02 - 4.070.0422.271.06 - 3.870.022
CLDN18.2 intensity 3+2.360.90 - 5.650.0502.621.09 - 3.870.031
HER2/EGFRvIII ≥ 5%1.891.02 - 3.490.0411.961.06 - 3.650.031
HER2/EGFRvIII ≥ 10%2.241.06 - 4.730.0332.451.15 - 5.210.020
EGFRvIII/CD44 ≥ 5%2.971.33 - 6.610.0082.971.33 - 6.610.008
CD109/CLDN18.2 ≥ 20%2.161.05 - 4.430.0352.061.00 - 4.250.048
HER2/EGFRvIII/CD44 ≥ 5%2.681.16 - 6.200.0212.681.16 - 6.200.021
EGFRvIII/CD44/CD109 ≥ 5%4.211.79 - 9.980.00094.211.79 - 9.980.0009