Hamdard Jamshid, Yücel Mehmet Haluk, Muğlu Harun, Açıkgöz Özgür, Çakır Aslı, Bilici Ahmet, Ölmez Ömer Fatih
Faculty of Medicine, Medical Oncology Department, Medipol University, 34214 İstanbul, Türkiye.
Faculty of Medicine, Medical Pathology Department, Medipol University, 34214 İstanbul, Türkiye.
J Clin Med. 2025 Apr 24;14(9):2937. doi: 10.3390/jcm14092937.
The goal of this study is to characterize the survival patterns and outcomes of women with early-stage breast cancer, with a particular emphasis on the distinction between HER2-low and HER2-zero expression. There is limited real-world data on how patients with HER2-negative or HER2-low metastatic or recurrent breast cancer are treated. We retrospectively analyzed the medical records of 1500 breast cancer patients diagnosed between January 2020 and December 2024. From this cohort, 99 patients with HER2-low and 34 patients with HER2-zero early-stage breast cancer were included in our analysis. HER2 low was defined as Immunohistochemistry (IHC) 1+ or IHC 2+ with negative Silver In situ Hybridization (SISH), while HER2 zero was defined as IHC 0. Statistical analyses, including Kaplan-Meier survival analyses and log-rank tests for group comparisons, were performed using IBM SPSS Statistics. The median age of patients was 55 years. The HER2-zero group exhibited a higher incidence of brain, liver, bone, and lung metastases ( < 0.001 for all) and increased use of CDK4/6 inhibitors ( < 0.001). In univariate analyses, younger age, an HER2-zero status, and the absence of metastases were associated with improved disease-free survival (DFS) and overall survival (OS). However, in multivariate analyses, an HER2-zero status independently predicted longer DFS (HR = 0.14, 95% CI: 0.05-0.41, < 0.001) and OS (HR = 0.16, 95% CI: 0.042-0.6, = 0.007). Our study revealed distinct metastatic patterns and survival outcomes between HER2-low and HER2-zero early-stage breast cancers. Despite a higher metastatic burden in univariate analyses, HER2 zero status was independently associated with longer DFS and OS in multivariate analyses, highlighting their biological heterogeneity and the need for further research to inform tailored strategies.
本研究的目的是描述早期乳腺癌女性的生存模式和结局，特别强调HER2低表达和HER2零表达之间的区别。关于HER2阴性或HER2低表达的转移性或复发性乳腺癌患者的治疗，现实世界的数据有限。我们回顾性分析了2020年1月至2024年12月期间确诊的1500例乳腺癌患者的病历。在这个队列中，99例HER2低表达和34例HER2零表达的早期乳腺癌患者被纳入我们的分析。HER2低表达定义为免疫组织化学（IHC）1+或IHC 2+且银原位杂交（SISH）阴性，而HER2零表达定义为IHC 0。使用IBM SPSS Statistics进行统计分析，包括Kaplan-Meier生存分析和用于组间比较的对数秩检验。患者的中位年龄为55岁。HER2零表达组脑、肝、骨和肺转移的发生率更高（所有均<0.001），且CDK4/6抑制剂的使用增加（<0.001）。在单变量分析中，年龄较小、HER2零表达状态和无转移与无病生存期（DFS）和总生存期（OS）的改善相关。然而，在多变量分析中，HER2零表达状态独立预测更长的DFS（HR = 0.14，95%CI：0.05 - 0.41，<0.001）和OS（HR = 0.16，95%CI：0.042 - 0.6，= 0.007）。我们的研究揭示了HER2低表达和HER2零表达的早期乳腺癌之间不同的转移模式和生存结局。尽管在单变量分析中转移负担较高，但在多变量分析中HER2零表达状态与更长的DFS和OS独立相关，突出了它们的生物学异质性以及进一步研究以制定个性化策略的必要性。
