HER2 低表达乳腺癌的临床特征、肿瘤浸润淋巴细胞与预后：与 HER2 阴性和 HER2 阳性疾病的对比研究。
Clinical characteristics, tumor-infiltrating lymphocytes, and prognosis in HER2-low breast cancer: A comparison study with HER2-zero and HER2-positive disease.
机构信息
Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Cancer Med. 2023 Aug;12(15):16264-16278. doi: 10.1002/cam4.6290. Epub 2023 Jun 27.
INTRODUCTION
HER2-low breast cancer is a gradually recognized and unexplored group of diseases. We aimed to investigate the clinical and prognosis features and to identify the role of stromal tumor-infiltrating lymphocytes (sTILs) in this population.
METHODS
Consecutive primary breast cancer patients treated between January 2009 to June 2013 were retrospectively reviewed. HER2-low was defined as immunohistochemistry (IHC) 1+, or 2+ and fluorescence in situ hybridization (FISH) negative. sTILs were scored following the international guidelines. Clinicopathologic features and survival were compared according to HER2 and sTILs category.
RESULTS
A total of 973 breast cancer patients were enrolled, including 615 (63.2%) HER2-low patients. HER2-low patients shared more similarity with HER2-0 cases in clinicopathological features. sTILs in HER2-Low patients was comparable to HER2-0 patients (p = 0.064), both significantly lower than HER2-positive ones (p < 0.001). Meanwhile, tumors with sTILs ≥50% accounted for the least proportion of HER2-low cases (p < 0.001). HER2 status had no significant influence on recurrence-free survival (RFS, p = 0.901) in the whole population. However, in the estrogen receptor (ER)-negative subgroup, HER2-low was related to worse RFS (p = 0.009) and OS (p = 0.001) compared with HER2-positive ones. sTILs increment was an independent favorable prognostic factor in the whole (OS, p = 0.003; RFS, p = 0.005) and HER2-low population (OS, p = 0.007; RFS, p = 0.009) after adjusted to clinicopathological parameters.
CONCLUSIONS
HER2-low patients shared similar clinicopathological features with HER2-0 rather than HER2-positive cases and had relatively low sTILs. ER-negative/HER2-low patients had significantly inferior survival. sTILs increment was independently associated with favorable survival in the HER2-low group, suggesting a potential benefit from a novel treatment strategy.
简介
HER2 低表达乳腺癌是一类逐渐被认识但尚未充分研究的疾病。本研究旨在探讨该人群的临床和预后特征，并确定肿瘤间质浸润淋巴细胞（sTILs）的作用。
方法
回顾性分析了 2009 年 1 月至 2013 年 6 月期间连续接受治疗的原发性乳腺癌患者。HER2 低表达定义为免疫组化（IHC）1+或 2+，荧光原位杂交（FISH）阴性。根据国际指南对 sTILs 进行评分。根据 HER2 和 sTILs 分类比较临床病理特征和生存情况。
结果
共纳入 973 例乳腺癌患者，其中 615 例（63.2%）为 HER2 低表达患者。HER2 低表达患者的临床病理特征与 HER2-0 患者更为相似。HER2-Low 患者的 sTILs 与 HER2-0 患者相当（p=0.064），均显著低于 HER2 阳性患者（p<0.001）。同时，sTILs≥50%的肿瘤在 HER2 低表达病例中所占比例最低（p<0.001）。HER2 状态对全人群无病生存（RFS，p=0.901）无显著影响。然而，在雌激素受体（ER）阴性亚组中，与 HER2 阳性患者相比，HER2 低表达与更差的 RFS（p=0.009）和 OS（p=0.001）相关。sTILs 增加是全人群（OS，p=0.003；RFS，p=0.005）和 HER2 低表达人群（OS，p=0.007；RFS，p=0.009）独立的预后良好因素，调整临床病理参数后。
结论
HER2 低表达患者的临床病理特征与 HER2-0 患者相似，而非 HER2 阳性患者，且 sTILs 相对较低。ER 阴性/HER2 低表达患者的生存明显较差。sTILs 增加与 HER2 低表达组的生存良好相关，提示可能从新的治疗策略中获益。
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