2021
Rapid Progression After 177Lu-DOTATATE in Patients With Neuroendocrine Tumors
Assi HA, Hornbacker K, Shaheen S, Wittenberg T, Silberman R, Kunz PL. Rapid Progression After 177Lu-DOTATATE in Patients With Neuroendocrine Tumors. Pancreas 2021, 50: 890-894. PMID: 34398071, DOI: 10.1097/mpa.0000000000001841.Peer-Reviewed Original ResearchConceptsPeptide receptor radionuclide therapyProgressive diseaseNeuroendocrine tumorsBiopsy-proven neuroendocrine tumorHigher disease control rateMedian progression-free survivalShorter progression-free intervalStanford Cancer CenterDisease control rateMetastatic neuroendocrine tumorsMonths of therapyProgression-free survivalProgression-free intervalReceptor radionuclide therapyBetter patient selectionLarge patient cohortHigh-grade componentHigher disease gradeLow-grade componentRepeat biopsyMedian timePatient selectionInitial pathologyPredictive factorsCancer CenterAnalysis of Survival Among Adults With Early-Onset Colorectal Cancer in the National Cancer Database
Cheng E, Blackburn HN, Ng K, Spiegelman D, Irwin ML, Ma X, Gross CP, Tabung FK, Giovannucci EL, Kunz PL, Llor X, Billingsley K, Meyerhardt JA, Ahuja N, Fuchs CS. Analysis of Survival Among Adults With Early-Onset Colorectal Cancer in the National Cancer Database. JAMA Network Open 2021, 4: e2112539. PMID: 34132794, PMCID: PMC8209612, DOI: 10.1001/jamanetworkopen.2021.12539.Peer-Reviewed Original ResearchConceptsEarly-onset colorectal cancerOnset colorectal cancerNational Cancer DatabaseColorectal cancerAge 51Overall survivalCancer DatabaseIncidence of CRCCox proportional hazards regressionPrimary colorectal cancerKaplan-Meier analysisProportional hazards regressionAge 50 yearsAge 25 yearsAnalysis of survivalCohort studySurvival benefitHazards regressionUnadjusted analysesCancer incidenceMAIN OUTCOMEAge 35Survival advantageLower riskStage I
2020
Time to Sustained Improvement in Bowel Movement Frequency with Telotristat Ethyl: Analyses of Phase III Studies in Carcinoid Syndrome
Dillon JS, Kulke MH, Hörsch D, Anthony LB, Warner RRP, Bergsland E, Welin S, O’Dorisio T, Kunz PL, McKee C, Lapuerta P, Banks P, Pavel M. Time to Sustained Improvement in Bowel Movement Frequency with Telotristat Ethyl: Analyses of Phase III Studies in Carcinoid Syndrome. Journal Of Gastrointestinal Cancer 2020, 52: 212-221. PMID: 32146619, PMCID: PMC7714089, DOI: 10.1007/s12029-020-00375-2.Peer-Reviewed Original ResearchConceptsCarcinoid syndrome diarrheaBM frequencyPhase III studyTelotristat ethylBowel movementsCarcinoid syndromeIII studySomatostatin analoguesDouble-blind treatment periodBowel movement frequencyMajority of patientsLog-rank testCox regression modelTime of onsetPlacebo TIDHazard ratioPrespecified analysisMedian timeSustained responseTreatment periodSustained reductionPatientsConsecutive weeksTELESTARSurvival analysis methods
2019
Prognostic value of somatostatin receptor expressing tumor volume calculated from 68Ga-DOTATATE PET/CT in patients with well-differentiated neuroendocrine tumors
Toriihara A, Baratto L, Nobashi T, Park S, Hatami N, Davidzon G, Kunz PL, Iagaru A. Prognostic value of somatostatin receptor expressing tumor volume calculated from 68Ga-DOTATATE PET/CT in patients with well-differentiated neuroendocrine tumors. European Journal Of Nuclear Medicine And Molecular Imaging 2019, 46: 2244-2251. PMID: 31350603, DOI: 10.1007/s00259-019-04455-9.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overDisease ProgressionDisease-Free SurvivalFemaleHumansImage Processing, Computer-AssistedKaplan-Meier EstimateLiver NeoplasmsMaleMiddle AgedMultivariate AnalysisNeoplasm MetastasisNeuroendocrine TumorsOrganometallic CompoundsPositron Emission Tomography Computed TomographyPrognosisProgression-Free SurvivalProportional Hazards ModelsProspective StudiesReceptors, SomatostatinRetrospective StudiesConceptsProgression-free survivalProportional hazards modelPET/CTPrognostic valueTumor volumeNeuroendocrine tumorsTumor gradeSomatostatin receptorsKaplan-Meier survival analysisCox proportional hazards modelPositron emission tomography/Volume of interestMaximum standardized uptake valueMethodsNinety-two patientsWHO tumor gradeLog-rank testSomatostatin receptor expressionEmission tomography/Standardized uptake valueSignificant differencesVolumetric parametersPrimary endpointIndependent predictorsResultsUnivariate analysisTomography/
2018
Long-Term Survivors of Pancreatic Cancer
Kardosh A, Lichtensztajn DY, Gubens MA, Kunz PL, Fisher GA, Clarke CA. Long-Term Survivors of Pancreatic Cancer. Pancreas 2018, 47: 958-966. PMID: 30074526, PMCID: PMC6095724, DOI: 10.1097/mpa.0000000000001133.Peer-Reviewed Original ResearchConceptsLong-term survivalPancreatic cancerPancreatic adenocarcinomaCalifornia Cancer RegistryLong-term survivorsPancreatic cancer mortalityAsian/Pacific IslandersNational Cancer InstituteNon-Hispanic whitesAdjuvant chemotherapyUnresectable patientsBaseline characteristicsSurgical resectionTerm survivorsCancer RegistryPoor prognosisSurgical interventionCancer CenterCancer mortalityDegree of differentiationCancer InstituteSurvival rateYounger ageLogistic regressionPatientsNCCN Guidelines Insights: Neuroendocrine and Adrenal Tumors, Version 2.2018.
Shah MH, Goldner WS, Halfdanarson TR, Bergsland E, Berlin JD, Halperin D, Chan J, Kulke MH, Benson AB, Blaszkowsky LS, Eads J, Engstrom PF, Fanta P, Giordano T, He J, Heslin MJ, Kalemkerian GP, Kandeel F, Khan SA, Kidwai WZ, Kunz PL, Kuvshinoff BW, Lieu C, Pillarisetty VG, Saltz L, Sosa JA, Strosberg JR, Sussman CA, Trikalinos NA, Uboha NA, Whisenant J, Wong T, Yao JC, Burns JL, Ogba N, Zuccarino-Catania G. NCCN Guidelines Insights: Neuroendocrine and Adrenal Tumors, Version 2.2018. Journal Of The National Comprehensive Cancer Network 2018, 16: 693-702. PMID: 29891520, DOI: 10.6004/jnccn.2018.0056.Peer-Reviewed Original ResearchConceptsPrimary neuroendocrine tumorNeuroendocrine tumorsAdrenal tumorsManagement of NETsLocoregional advanced diseaseNCCN Guidelines InsightsAdrenal gland tumorsAdvanced diseaseNCCN guidelinesAdult patientsDistant metastasisGastrointestinal tractGland tumorsTumorsNeuroendocrineManagement optionsGuidelinesPatientsPheochromocytomaMetastasisParagangliomaDiseaseTractTelotristat ethyl in carcinoid syndrome: safety and efficacy in the TELECAST phase 3 trial
Pavel M, Gross DJ, Benavent M, Perros P, Srirajaskanthan R, Warner RRP, Kulke MH, Anthony LB, Kunz PL, Hörsch D, Weickert MO, Lapuerta P, Jiang W, Kassler-Taub K, Wason S, Fleming R, Fleming D, Garcia-Carbonero R. Telotristat ethyl in carcinoid syndrome: safety and efficacy in the TELECAST phase 3 trial. Endocrine Related Cancer 2018, 25: 309-322. PMID: 29330194, PMCID: PMC5811631, DOI: 10.1530/erc-17-0455.Peer-Reviewed Original ResearchConceptsTreatment-emergent adverse eventsOpen-label extensionCarcinoid syndromeTelotristat ethylSomatostatin analoguesWeek 12Rates of TEAEsDouble-blind treatment periodPhase 3 trialTryptophan hydroxylase inhibitorMedian treatment differencesCS diarrheaBowel movementsEfficacy endpointAdverse eventsPrimary safetyTreatment periodHydroxylase inhibitorPatientsSerious eventsPercent changeTreatment differencesPlaceboEfficacySignificant reduction
2016
Neuroendocrine tumors of the pancreas: Degree of cystic component predicts prognosis
Cloyd JM, Kopecky KE, Norton JA, Kunz PL, Fisher GA, Visser BC, Dua MM, Park WG, Poultsides GA. Neuroendocrine tumors of the pancreas: Degree of cystic component predicts prognosis. Surgery 2016, 160: 708-713. PMID: 27216830, DOI: 10.1016/j.surg.2016.04.005.Peer-Reviewed Original ResearchConceptsCystic pancreatic neuroendocrine tumorsPancreatic neuroendocrine tumorsRecurrence-free survivalNeuroendocrine tumorsCystic tumorCystic componentSolid tumorsTumor sizeSingle academic medical centerMost pancreatic neuroendocrine tumorsFavorable clinicopathologic featuresSynchronous liver metastasesLymph node positivityLymph node metastasisTotal tumor sizeHigh gradeCross-sectional imagingAcademic medical centerSynchronous liverImmediate resectionLiver metastasesMetastatic diseaseNode positivityOperative resectionClinicopathologic characteristics
2015
Phase II pilot study of single-agent etirinotecan pegol (NKTR-102) in bevacizumab-resistant high grade glioma
Nagpal S, Recht CK, Bertrand S, Thomas RP, Ajlan A, Pena J, Gershon M, Coffey G, Kunz PL, Li G, Recht LD. Phase II pilot study of single-agent etirinotecan pegol (NKTR-102) in bevacizumab-resistant high grade glioma. Journal Of Neuro-Oncology 2015, 123: 277-282. PMID: 25935109, PMCID: PMC4452613, DOI: 10.1007/s11060-015-1795-0.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAngiogenesis InhibitorsAntineoplastic AgentsBevacizumabBrain NeoplasmsDrug Resistance, NeoplasmFemaleFollow-Up StudiesGliomaHeterocyclic Compounds, 4 or More RingsHumansMaleMiddle AgedNeoplasm GradingNeoplasm Recurrence, LocalPilot ProjectsPolyethylene GlycolsPrognosisProspective StudiesSurvival RateYoung AdultConceptsHigh-grade gliomasEtirinotecan pegolOverall survivalRANO criteriaPhase II pilot studyGrade 3 toxicityMedian overall survivalOpen-label trialFurther clinical investigationMedian KPSChemotherapy cyclesHematologic toxicityPrimary endpointSecondary endpointsPartial responseMedian agePatient agePoor prognosisHGG patientsTumor exposureClinical dataAnaplastic astrocytomaBevacizumabClinical investigationGrade gliomas
2014
Phase II clinical trial of pasireotide long-acting repeatable in patients with metastatic neuroendocrine tumors
Cives M, Kunz P, Morse B, Coppola D, Schell M, Campos T, Nguyen P, Nandoskar P, Khandelwal V, Strosberg J. Phase II clinical trial of pasireotide long-acting repeatable in patients with metastatic neuroendocrine tumors. Endocrine Related Cancer 2014, 22: 1-9. PMID: 25376618, PMCID: PMC4643672, DOI: 10.1530/erc-14-0360.Peer-Reviewed Original ResearchConceptsProgression-free survivalOverall radiographic response rateOverall survivalPasireotide LARSomatostatin analoguesFirst-line systemic agentMedian progression-free survivalPhase II clinical trialGrade 3 hyperglycemiaMetastatic grade 1Neuroendocrine tumor growthPrevious systemic therapyRadiographic response rateRates of hyperglycemiaGrade 3/4 toxicitiesMedian overall survivalMetastatic neuroendocrine tumorsPhase II studySolid Tumors criteriaTreatment-naïve patientsHepatic tumor burdenResponse Evaluation CriteriaNovel somatostatin analogReceptor subtype 1LAR treatmentSingle- versus Multifraction Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma: Outcomes and Toxicity
Pollom EL, Alagappan M, von Eyben R, Kunz PL, Fisher GA, Ford JA, Poultsides GA, Visser BC, Norton JA, Kamaya A, Cox VL, Columbo LA, Koong AC, Chang DT. Single- versus Multifraction Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma: Outcomes and Toxicity. International Journal Of Radiation Oncology • Biology • Physics 2014, 90: 918-925. PMID: 25585785, DOI: 10.1016/j.ijrobp.2014.06.066.Peer-Reviewed Original ResearchConceptsStereotactic body radiation therapyCumulative incidence rateSingle-fraction groupUnresectable pancreatic adenocarcinomaBody radiation therapyPancreatic adenocarcinomaToxicity gradeSurvival rateLocal recurrenceIncidence rateRadiation therapySingle-fraction stereotactic body radiation therapyGastrointestinal toxicity gradeMajority of patientsGastrointestinal toxicityMedian survivalWorse survivalIndependent predictorsPancreatic cancerLocal controlPatientsAdenocarcinomaRecurrenceTherapyMonthsPostradiotherapy CA19-9 Kinetics Correlate With Outcomes in Patients With Pancreatic Adenocarcinoma
Shultz DB, Chan C, Shaffer JL, Kunz PL, Koong AC, Chang DT. Postradiotherapy CA19-9 Kinetics Correlate With Outcomes in Patients With Pancreatic Adenocarcinoma. Pancreas 2014, 43: 777-783. PMID: 24632549, DOI: 10.1097/mpa.0000000000000098.Peer-Reviewed Original ResearchConceptsPostoperative chemoradiotherapyPancreatic ductal adenocarcinomaDuctal adenocarcinomaNonmetastatic pancreatic ductal adenocarcinomaCA19-9 kineticsPretreatment CA19-9Carbohydrate antigen 19Definitive chemoradiotherapyRadiotherapy correlatesOverall survivalMultivariable analysisAntigen 19CA19-9Disease progressionPancreatic adenocarcinomaTreatment decisionsChemoradiotherapyPrognostic toolPatientsKinetics correlateAdenocarcinomaRT correlateFFPTTNProgression
2013
Reassessment of the Current American Joint Committee on Cancer Staging System for Pancreatic Neuroendocrine Tumors
Qadan M, Ma Y, Visser BC, Kunz PL, Fisher GA, Norton JA, Poultsides GA. Reassessment of the Current American Joint Committee on Cancer Staging System for Pancreatic Neuroendocrine Tumors. Journal Of The American College Of Surgeons 2013, 218: 188-195. PMID: 24321190, DOI: 10.1016/j.jamcollsurg.2013.11.001.Peer-Reviewed Original ResearchConceptsPancreatic neuroendocrine tumorsAmerican Joint CommitteeStaging systemTNM systemOverall survivalSurgical resectionAJCC systemNeuroendocrine tumorsStage IIIJoint CommitteeCurative-intent surgical resectionEnd Results program dataStage IICurrent American Joint CommitteeCurrent AJCC staging systemCurrent AJCC systemDistant metastatic diseaseUnified staging systemDiscriminatory abilityCancer (AJCC) staging systemAJCC staging systemLymph node metastasisImproved discriminatory abilityNew TNM systemTNM subgroupsPancreatic neuroendocrine tumours: hypoenhancement on arterial phase computed tomography predicts biological aggressiveness
Worhunsky DJ, Krampitz GW, Poullos PD, Visser BC, Kunz PL, Fisher GA, Norton JA, Poultsides GA. Pancreatic neuroendocrine tumours: hypoenhancement on arterial phase computed tomography predicts biological aggressiveness. Hepato Pancreato Biliary 2013, 16: 304-311. PMID: 23991643, PMCID: PMC3967881, DOI: 10.1111/hpb.12139.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedCell DifferentiationChi-Square DistributionFemaleHumansKaplan-Meier EstimateMaleMiddle AgedMultivariate AnalysisNeuroendocrine TumorsPancreatectomyPancreatic NeoplasmsPredictive Value of TestsProportional Hazards ModelsRetrospective StudiesRisk FactorsTime FactorsTomography, X-Ray ComputedTreatment OutcomeConceptsPancreatic neuroendocrine tumorsOverall survivalArterial phasePre-operative decisionsSynchronous liver metastasesWorse overall survivalMultidisciplinary treatmentSurgical resectionIndependent predictorsLiver metastasesLymph nodesPoor outcomePrognostic significanceClinicopathological variablesNeuroendocrine tumorsCT appearancePancreatic adenocarcinomaBiological aggressivenessTumor enhancementMultivariate analysisTumorsHypoenhancementIntermediate gradeResectionPatientsPhase II Study Evaluating 2 Dosing Schedules of Oral Foretinib (GSK1363089), cMET/VEGFR2 Inhibitor, in Patients with Metastatic Gastric Cancer
Shah MA, Wainberg ZA, Catenacci DV, Hochster HS, Ford J, Kunz P, Lee FC, Kallender H, Cecchi F, Rabe DC, Keer H, Martin AM, Liu Y, Gagnon R, Bonate P, Liu L, Gilmer T, Bottaro DP. Phase II Study Evaluating 2 Dosing Schedules of Oral Foretinib (GSK1363089), cMET/VEGFR2 Inhibitor, in Patients with Metastatic Gastric Cancer. PLOS ONE 2013, 8: e54014. PMID: 23516391, PMCID: PMC3597709, DOI: 10.1371/journal.pone.0054014.Peer-Reviewed Original ResearchConceptsObjective response rateMetastatic gastric cancerStable diseaseMET amplificationPhospho-METGastric adenocarcinomaIntermittent dosingGastric cancerTreatment-related adverse eventsPhase II studyMetastatic gastric adenocarcinomaRates of hypertensionElevated aspartate aminotransferaseOral multikinase inhibitorEndothelial cell growth factorVascular endothelial cell growth factorCell growth factorEvaluable patientsForetinib treatmentPrior therapyAdverse eventsII studyUnselected patientsDosing schedulesMedian age
2012
Neoadjuvant imatinib for borderline resectable GIST.
Koontz MZ, Visser BM, Kunz PL. Neoadjuvant imatinib for borderline resectable GIST. Journal Of The National Comprehensive Cancer Network 2012, 10: 1477-82; quiz 1482. PMID: 23221786, DOI: 10.6004/jnccn.2012.0154.Peer-Reviewed Original ResearchConceptsGastrointestinal stromal tumorsNeoadjuvant imatinibNeoadjuvant tyrosine kinase-inhibitor therapyResectable gastrointestinal stromal tumorsTyrosine kinase inhibitor therapyBorderline resectable tumorsCommon bile ductSuperior mesenteric veinKinase inhibitor therapyOptimal imaging modalityViable treatment strategySpindle cell neoplasmResectable tumorsRed blood cellsUpper endoscopyBlack stoolInhibitor therapyBile ductMedical oncologyStromal tumorsEmergency departmentCase reportMesenteric veinCell neoplasmsTreatment strategiesSeventh Edition (2010) of the AJCC/UICC Staging System for Gastric Adenocarcinoma: Is there Room for Improvement?
Patel MI, Rhoads KF, Ma Y, Ford JM, Visser BC, Kunz PL, Fisher GA, Chang DT, Koong A, Norton JA, Poultsides GA. Seventh Edition (2010) of the AJCC/UICC Staging System for Gastric Adenocarcinoma: Is there Room for Improvement? Annals Of Surgical Oncology 2012, 20: 1631-1638. PMID: 23149854, DOI: 10.1245/s10434-012-2724-5.Peer-Reviewed Original ResearchMeSH KeywordsAdenocarcinomaAdolescentAdultAgedAged, 80 and overCaliforniaChemotherapy, AdjuvantFemaleGastrectomyHumansKaplan-Meier EstimateLymphatic MetastasisMaleMiddle AgedNeoplasm StagingProportional Hazards ModelsRadiotherapy, AdjuvantRetrospective StudiesStomach NeoplasmsTreatment OutcomeYoung AdultConceptsAJCC/UICC staging systemUICC staging systemStaging systemStage IBLymph nodesGastric adenocarcinomaAJCC/UICC stageAJCC/UICC systemCurative-intent surgical resectionSeventh editionKaplan-Meier methodOverall survival probabilityStatewide Health PlanningCancer registry dataNew grouping systemAdjuvant chemotherapyAdjuvant radiotherapySurgical resectionMedian ageUICC stageAsian patientsDischarge abstractsMedian numberRegistry dataGastric cancerPancreatic Neuroendocrine Tumors: Radiographic Calcifications Correlate with Grade and Metastasis
Poultsides GA, Huang LC, Chen Y, Visser BC, Pai RK, Brooke Jeffrey R, Park WG, Chen AM, Kunz PL, Fisher GA, Norton JA. Pancreatic Neuroendocrine Tumors: Radiographic Calcifications Correlate with Grade and Metastasis. Annals Of Surgical Oncology 2012, 19: 2295-2303. PMID: 22396008, DOI: 10.1245/s10434-012-2305-7.Peer-Reviewed Original ResearchMeSH KeywordsAdenocarcinomaAdenoma, Islet CellAdultAgedCalcinosisFemaleFollow-Up StudiesGastrinomaHumansInsulinomaLiver NeoplasmsLymphatic MetastasisMaleMiddle AgedNeoplasm StagingNeoplasms, Multiple PrimaryNeuroendocrine TumorsPancreatectomyPancreatic NeoplasmsPrognosisRetrospective StudiesStomach NeoplasmsTomography, X-Ray ComputedConceptsPancreatic neuroendocrine tumorsSynchronous liver metastasesLymph node metastasisLiver metastasesNode metastasisOverall survivalRadiographic calcificationsHigh-grade pancreatic neuroendocrine tumorsComputed tomography correlateIntermediate tumor gradeRegional lymph nodesPreoperative computed tomographyPresence of calcificationCurative intentFormal pancreatectomyMethodsFrom 1998Surgical resectionIndependent predictorsLymph nodesPrognostic significanceCalcified tumorClinicopathologic variablesNeuroendocrine tumorsPrimary tumorTumor gradePhase I trial of ixabepilone administered as three oral doses each separated by 6 hours every 3 weeks in patients with advanced solid tumors
Kunz PL, He AR, Colevas AD, Pishvaian MJ, Hwang JJ, Clemens PL, Messina M, Kaleta R, Abrahao F, Sikic BI, Marshall JL. Phase I trial of ixabepilone administered as three oral doses each separated by 6 hours every 3 weeks in patients with advanced solid tumors. Investigational New Drugs 2012, 30: 2364-2370. PMID: 22331549, PMCID: PMC3703248, DOI: 10.1007/s10637-012-9800-3.Peer-Reviewed Original ResearchConceptsNeutropenic sepsisGrade 4 febrile neutropeniaDoses of ixabepiloneAdvanced solid tumorsExcellent performance statusPhase I trialSerial plasma samplesPlasma drug concentrationsRefractory advanced cancersHigh inter-individual variabilityFebrile neutropeniaPerformance statusI trialMedian ageAdvanced cancerInter-individual variabilityOral dosesSafety profileCohort 2Cohort 1Cohort 3PK variabilityOral formulationIxabepilonePatientsHER2 Expression in Gastric and Gastroesophageal Junction Adenocarcinoma in a US Population
Kunz PL, Mojtahed A, Fisher GA, Ford JM, Chang DT, Balise RR, Bangs CD, Cherry AM, Pai RK. HER2 Expression in Gastric and Gastroesophageal Junction Adenocarcinoma in a US Population. Applied Immunohistochemistry & Molecular Morphology 2012, 20: 13-24. PMID: 21617522, PMCID: PMC6402787, DOI: 10.1097/pai.0b013e31821c821c.Peer-Reviewed Original ResearchMeSH KeywordsAdenocarcinomaAdultAgedAged, 80 and overBreast NeoplasmsEsophageal NeoplasmsFemaleFollow-Up StudiesGene Expression Regulation, NeoplasticHumansImmunohistochemistryIn Situ Hybridization, FluorescenceIncidenceMaleMiddle AgedReceptor, ErbB-2Retrospective StudiesStomach NeoplasmsUnited StatesConceptsGastroesophageal junction cancerHER2-positive adenocarcinomaGastroesophageal junction carcinomaJunction cancerHER2 expressionHER2 statusClinical Oncology/CollegeHER2-positive gastricGastroesophageal junction adenocarcinomaGastric Cancer TrialIntestinal-type adenocarcinomaPrimary tumor siteMembranous staining patternHER2/CEP17 ratioPrimary gastric adenocarcinomaTissue microarray approachASCO/CAPHER2 gene amplificationHER2 protein expressionJunction adenocarcinomaDiffuse adenocarcinomaGastroesophageal junctionPatient survivalTherapeutic optionsIntestinal type