HER2低表达乳腺癌新辅助化疗效果及其预后特征：一项单中心回顾性研究

王若曦, 吉芃, 龚悦, 陈盛

  1. 复旦大学附属肿瘤医院乳腺外科，复旦大学上海医学院肿瘤学系，上海 200032
  • 收稿日期:2023-03-29 修回日期:2023-05-30 出版日期:2023-07-30 发布日期:2023-08-10
  • 通信作者: 陈盛 E-mail:0456177@fudan.edu.cn.;0456177@fudan.edu.cn
  • 作者简介:王若曦（ORCID: 0009-0000-9474-3240），博士，主治医师。
  • 基金资助:
    国家自然科学基金(82203097)

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摘要/Abstract

摘要：

背景与目的：人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）是影响乳腺癌患者预后的主要标志物之一，也是乳腺癌病理学分型最主要的参考因素。本研究旨在探讨HER2低表达（HER2-low）乳腺癌患者的临床病理学特征，以及其在新辅助化疗中与疗效及预后的相关性。方法：回顾性纳入2009—2018年于复旦大学附属肿瘤医院接受新辅助化疗的HER2阴性乳腺癌患者的临床病理学相关信息，并将患者区分为HER2-low及无表达（HER2-0）组，分析其特征差异，采用单因素和多因素分析评估新辅助化疗后达病理学完全缓解（pathological complete response，pCR）的独立影响因素，采用Kaplan-Meier曲线评估不同HER2表达组的预后差异。结果：入组的772例患者中激素受体（hormonal receptor，HR）阳性患者的HER2-low比例显著高于HR阴性患者。Logistic回归模型多因素分析结果显示，肿瘤大小（P<0.001）、HR（P = 0.026）及HER2表达（P = 0.018）是pCR的独立预测因素。亚组分析提示，在三阴性乳腺癌（triple-negative breast cancer，TNBC）中，HER2-0与HER2-low的pCR率差异无统计学意义（P = 0.598）；而在Luminal型乳腺癌中，HER2-low患者pCR率为9.4%，显著低于HER2-0的19.3%（P = 0.003）。在非pCR（non-pCR）患者的生存分析中，HER2-low患者的预后显著优于HER2-0患者（P<0.001），其5年生存率达72.2%，而HER2-0仅为56.0%。结论：HER2蛋白表达不同的HER2阴性患者具有不同的临床病理学特征，并与患者的化疗敏感性及预后有关。

关键词: 人表皮生长因子受体2, 乳腺癌, 新辅助治疗, 病理学完全缓解, 预后

Abstract:

Background and purpose: Human epidermal growth factor receptor 2 (HER2) is one of the main markers affecting the prognosis of breast cancer patients and the most important reference factor for the pathological classification of breast cancer. This study aimed to investigate the clinicopathological features of breast cancer with low expression of HER2 and its correlation with therapeutic effect and prognosis in neoadjuvant chemotherapy. Methods: The patients with HER2-negative breast cancer who received neoadjuvant chemotherapy in Fudan University Shanghai Cancer Center from 2009 to 2018 were retrospectively included. Clinicopathological information was collected, and the patients were divided into groups with low expression of HER2 (HER2-low) and no expression of HER2 (HER2-0), and their characteristic differences were analyzed. The independent influencing factors of pathological complete response (pCR) after neoadjuvant chemotherapy were evaluated by univariate and multifactorial methods, and the prognostic differences among different HER2 expression groups were evaluated by Kaplan-Meier curve. Results: In the 772 patients enrolled in this study, the proportion of HER2-low was significantly higher in hormonal receptor (HR) positive patients than in HR negative patients. Multivariate analysis of logistic regression model showed that tumor size (P<0.001), HR (P = 0.026) and HER2 expression (P = 0.018) were independent predictors of pCR. Subgroup analysis indicated that there was no significant difference in pCR rates between HER2-0 and HER2-low triple-negative breast cancer (TNBC) (P = 0.598). In Luminal breast cancer, the pCR rate of HER2-low patients was 9.4%, which was significantly lower compared with HER2-0 patients (19.3%, P = 0.003). In the survival analysis of non-pCR patients, the prognosis of HER2-low patients was significantly better compared with HER2-0 patients (P<0.001), and the 5-year survival rate was 72.2%, while the 5-year survival rate of HER2-0 patients was only 56.0%. Conclusion: HER2-negative patients with different expressions of HER2 protein have different clinicopathological characteristics, which are related to the chemotherapy sensitivity and prognosis of patients.

Key words: Human epidermal growth factor receptor 2, Breast cancer, Neoadjuvant chemotherapy, Pathological complete response, Prognosis

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