Lu Yujie, Zhu Siji, Wu Chenghui, Fei Xiaochun, Shen Kunwei, Chen Xiaosong
Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Chin J Cancer Res. 2024 Dec 30;36(6):729-741. doi: 10.21147/j.issn.1000-9604.2024.06.10.
To explore the prognosis-predictive influence of human epidermal growth factor receptor 2 (HER2)-low status in breast cancer patients after neoadjuvant therapy (NAT).
Consecutive patients with invasive breast cancer who underwent NAT and surgery from January 2009 to December 2020 at multiple centers were included. A modified CPS+EG scoring system that integrates HER2-low status, CPS+EGH was developed. Multiple scoring systems were compared via receiver operating characteristic curves with the area under curve (AUC), the Akaike information criterion, the C-index, and calibration curves.
A total of 2,141 patients were included: 1,074, 640, and 427 patients in the training, internal validation, and external validation groups, respectively. HER2-low patients had a significantly better breast cancer-specific survival (BCSS, P=0.008) and recurrence-free interval (RFI, P=0.030) compared to HER2-zero patients (P=0.038) but inferior outcomes than HER2-amplified ones (BCSS, P=0.002; RFI, P<0.001). The CPS+EGH (AUC: 0.846, 0.817, 0.901) could stratify patients according to BCSS in training, internal validation, and external validation group, respectively, overperforming pathological stage (PS) (AUC: 0.746, 0.779, 0.754), CPS+EG (AUC: 0.771, 0.752, 0.748), and Neo-Bioscore (AUC: 0.783, 0.777, 0.786, all P<0.05).
HER2-low status showed a significant prognostic value in breast cancer patients after NAT. The CPS+EGH model significantly outperformed PS, CPS+EG, and Neo-Bioscore in clinical outcome prediction, which may guide further therapy targeting HER2-low.
探讨新辅助治疗（NAT）后乳腺癌患者中人类表皮生长因子受体2（HER2）低表达状态对预后的预测影响。
纳入2009年1月至2020年12月在多个中心接受NAT和手术的连续性浸润性乳腺癌患者。开发了一种整合HER2低表达状态的改良CPS+EG评分系统CPS+EGH。通过受试者工作特征曲线，比较多个评分系统的曲线下面积（AUC）、赤池信息准则、C指数和校准曲线。
共纳入2141例患者，训练组、内部验证组和外部验证组分别有1074例、640例和427例患者。与HER2零表达患者相比，HER2低表达患者的乳腺癌特异性生存（BCSS，P=0.008）和无复发生存期（RFI，P=0.030）显著更好，但预后比HER2扩增患者差（BCSS，P=0.002；RFI，P<0.001）。CPS+EGH（AUC：0.846、0.817、0.901）在训练组、内部验证组和外部验证组中分别可根据BCSS对患者进行分层，优于病理分期（PS）（AUC：0.746、0.779、0.754）、CPS+EG（AUC：0.771、0.752、0.748）和Neo-Bioscore（AUC：0.783、0.777、0.786，均P<0.05）。
HER2低表达状态在NAT后的乳腺癌患者中显示出显著的预后价值。CPS+EGH模型在临床结局预测方面显著优于PS、CPS+EG和Neo-Bioscore，这可能为针对HER2低表达的进一步治疗提供指导。
