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Clinical significance of HER2-low expression in early breast cancer: a nationwide study from the Korean Breast Cancer Society

Authors
Won, Hye SungAhn, JuneyoungKim, YongseonKim, Jin SungSong, Jeong-YoonKim, Hong-KyuLee, JeeyeonPark, Heung KyuKim, Yong-Seok
Issue Date
21-Mar-2022
Publisher
BMC
Keywords
Breast cancer; HER2-low; Prognosis
Citation
BREAST CANCER RESEARCH, v.24, no.1
Journal Title
BREAST CANCER RESEARCH
Volume
24
Number
1
URI
https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/83943
DOI
10.1186/s13058-022-01519-x
ISSN
1465-5411
Abstract
Background There is an increasing interest in HER2-low breast cancer with promising data from clinical trials using novel anti-HER2 antibody-drug conjugates. We explored the differences in clinicopathological characteristics and survival outcomes between HER2-low and HER2-IHC 0 breast cancer. Methods Using nationwide data from the Korean Breast Cancer Registry between 2006 and 2011, 30,491 patients with stages I to III breast cancer were included in the analysis: 9,506 (31.2%) in the HER2-low group and 20,985 (68.8%) in the HER2-IHC 0 group. Kaplan-Meier and Cox proportional hazards regression survival analysis were used to compare breast cancer-specific survival between the two groups. Results HER2-low breast cancer was more frequent in patients with hormone receptor-positive breast cancer than in those with triple-negative breast cancer. In patients with hormone receptor-positive breast cancer, HER2-low breast cancer was associated with fewer T4 tumors, higher histological grade, and a negative lymphatic invasion. In patients with triple-negative breast cancer, HER2-low breast cancer was associated with a high lymph node ratio and positive lymphatic invasion. HER2-low breast cancer was significantly associated with a lower Ki-67 labeling index. No significant difference was observed in overall survival between the two groups. HER2-low breast cancer showed significantly better breast cancer-specific survival than HER2-IHC 0 breast cancer, regardless of the hormone receptor status. In multivariate analysis, the impact of low HER2 expression on breast cancer-specific survival was significant only in triple-negative breast cancer (HRs, 0.68; 95% CI, 0.49-0.93; P = 0.019). Conclusions These findings suggest that the biology and clinical impact of low HER2 expression can differ according to the hormone receptor status and support the need for further investigation on the understanding of the biology of HER2-low breast cancer.
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