Division of Breast Surgery, Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Division of Breast Surgery, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Medicine, Seoul, Korea.
Breast Cancer Res Treat. 2020 Apr;180(2):461-470. doi: 10.1007/s10549-020-05550-4. Epub 2020 Feb 4.
The effect of human epidermal growth factor receptor 2 (HER2) status on mucinous carcinoma (MC) of the breast is unknown due to the rarity of HER2-positive cases. We evaluated the prognostic value of HER2 status and the efficacy of anti-HER2 therapy in patients with hormone receptor (HR)-positive MC.
From the data of 154,661 patients recorded in the Korean Breast Cancer Registry between January 1990 and August 2016, 3076 (2.0%) were diagnosed with MC. Overall survival (OS) according to HER2 status and anti-HER2 therapy was analyzed using Kaplan-Meier estimates. Multivariate analysis was performed using the Cox proportional hazards model to estimate the adjusted hazards ratio (HR) for clinicopathologic factors.
A total of 2716 HR-positive MC patients were enrolled and followed up for a median 100.1 months. Of these, 2094 (77.1%) were HER2-negative and 228 (8.4%) were HER2-positive. HR-positive, HER2-positive MC patients had more advanced pathologic tumor stages (T3 or T4) (p = 0.001), more axillary lymph node involvement (p < 0.001), higher nuclear grade (p < 0.001), and more lymphovascular invasion (p = 0.012) than HER2-negative patients. Subgroup analysis of HR-positive, node-positive MC showed that HER2-positive MC was an independent prognostic factor for OS (HR = 2.657; 95% CI, 1.665-4.241; p < 0.001). HR-positive, node-positive, and HER2-negative MC had significantly longer OS than HER2-positive MBC (p = 0.017). The node-positive subgroup that received anti-HER2 therapy had increased OS, although not significantly (p = 0.224).
Our nationwide database study revealed that HER2-positive status was associated with worse prognosis in HR-positive and node-positive MC. Anti-HER2 therapy might be beneficial in HR-positive, node-positive, and HER2-positive MC.
由于 HER2 阳性病例罕见，HER2 状态对乳腺黏液癌（MC）的影响尚不清楚。我们评估了 HER2 状态的预后价值和抗 HER2 治疗在激素受体（HR）阳性 MC 患者中的疗效。
从 1990 年 1 月至 2016 年 8 月期间韩国乳腺癌登记处记录的 154661 名患者的数据中，有 3076 名（2.0%）被诊断为 MC。使用 Kaplan-Meier 估计法分析根据 HER2 状态和抗 HER2 治疗的总生存期（OS）。使用 Cox 比例风险模型进行多变量分析，以估计临床病理因素的调整风险比（HR）。
共纳入 2716 例 HR 阳性 MC 患者，中位随访 100.1 个月。其中，2094 例（77.1%）为 HER2 阴性，228 例（8.4%）为 HER2 阳性。HR 阳性、HER2 阳性 MC 患者具有更晚期的病理肿瘤分期（T3 或 T4）（p=0.001）、更多的腋窝淋巴结受累（p<0.001）、更高的核分级（p<0.001）和更多的脉管侵犯（p=0.012）比 HER2 阴性患者。HR 阳性、淋巴结阳性 MC 的亚组分析显示，HER2 阳性 MC 是 OS 的独立预后因素（HR=2.657；95%CI，1.665-4.241；p<0.001）。HR 阳性、淋巴结阳性且 HER2 阴性 MC 的 OS 明显长于 HER2 阳性转移性乳腺癌（MBC）（p=0.017）。尽管没有显著意义（p=0.224），但接受抗 HER2 治疗的淋巴结阳性亚组的 OS 增加。
我们的全国性数据库研究表明，HER2 阳性状态与 HR 阳性和淋巴结阳性 MC 的预后较差相关。抗 HER2 治疗可能对 HR 阳性、淋巴结阳性和 HER2 阳性 MC 有益。
