Department of Gynecology and Obstetrics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen; Comprehensive Cancer Center Erlangen-EMN (CCC-ER-EMN), Erlangen.
Comprehensive Cancer Center Erlangen-EMN (CCC-ER-EMN), Erlangen; Institute of Pathology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen.
ESMO Open. 2024 Nov;9(11):103963. doi: 10.1016/j.esmoop.2024.103963. Epub 2024 Oct 26.
Prognostication has been used to identify patient populations that could potentially benefit from treatment de-escalation. In patients with hormone receptor-positive (HRpos), human epidermal growth factor receptor 2-negative (HER2neg) early breast cancer (eBC), treatment de-escalation classically involved omitting chemotherapy. With recently developed specialized therapies that require hands-on side-effect management, the therapeutic landscape is changing and therapy decisions are no longer based only on prognosis, but also consider potential side-effects. Therefore, identification of patient groups based on prognostication has gained importance.
In this retrospective analysis, a population of 2359 node-negative HRpos/HER2neg eBC patients was selected from all patients treated at the University Breast Center of Franconia, Germany between 2002 and 2021. The prognostic value of the IHC3 score (incorporating immunohistochemical measurements of the estrogen and progesterone receptor status and Ki-67) with clinical parameters (lymph node status, tumor stage, grading) regarding invasive disease-free survival (iDFS) and overall survival (OS) was assessed.
IHC3 positively correlated with Ki-67 expression and inversely correlated with hormone receptor expression. IHC3 categorized into quartiles identified patients with a more unfavorable prognosis: 5-year and 10-year iDFS rates for patients in the highest versus the lowest quartile were 84% versus 95% and 70% versus 88%, respectively. A sensitivity analysis of distant disease-free survival showed similar results to those of iDFS. Five-year and 10-year OS rates for patients in the highest versus the lowest quartile were, respectively, 92% versus 97% and 81% versus 92%.
IHC3 is able to define prognostic groups in patients with node-negative, HRpos/HER2neg eBC. Node-negative patients with a high IHC3 score had the worst prognosis, which was comparable to that of node-positive patients described in recent trials. This simple and cost-effective tool could thus potentially aid in identifying patient groups for innovative therapeutic approaches.
预测已被用于识别可能从治疗降级中获益的患者群体。在激素受体阳性（HRpos）、人表皮生长因子受体 2 阴性（HER2neg）早期乳腺癌（eBC）患者中，治疗降级传统上涉及省略化疗。随着最近开发的需要实际处理副作用的专门疗法，治疗领域正在发生变化，治疗决策不再仅基于预后，还考虑潜在的副作用。因此，基于预测的患者群体的识别变得越来越重要。
在这项回顾性分析中，从德国弗兰肯大学乳房中心在 2002 年至 2021 年间治疗的所有患者中选择了 2359 例淋巴结阴性 HRpos/HER2neg eBC 患者。评估免疫组织化学 3 评分（包含雌激素和孕激素受体状态以及 Ki-67 的免疫组织化学测量）与临床参数（淋巴结状态、肿瘤分期、分级）对无侵袭性疾病生存（iDFS）和总生存（OS）的预后价值。
IHC3 与 Ki-67 表达呈正相关，与激素受体表达呈负相关。IHC3 分为四分位数，确定了预后较差的患者：处于最高四分位数与最低四分位数的患者，5 年和 10 年 iDFS 率分别为 84%和 95%与 70%和 88%。远处无病生存的敏感性分析显示与 iDFS 相似的结果。处于最高四分位数与最低四分位数的患者，5 年和 10 年 OS 率分别为 92%和 97%与 81%和 92%。
IHC3 能够在淋巴结阴性、HRpos/HER2neg eBC 患者中定义预后组。IHC3 评分高的淋巴结阴性患者预后最差，与最近试验中描述的淋巴结阳性患者相当。因此，这种简单且具有成本效益的工具可能有助于识别创新治疗方法的患者群体。
