Prognostic analysis of the patients with HER2-positive breast cancer adjuvant treated with trastuzumab: a report of 1 246 cases

doi:10.16139/j.1007-9610.2023.05.13

Abstract

Abstract:

Objective To analyze the prognostic factors in the patients with HER2-positive breast cancer adjuvant treated with trastuzumab. Methods We conducted a retrospective analysis of clinical data of 1 246 patients diagnosed with HER2-positive breast cancer between January 2009 and December 2019 who received treatment with trastuzumab. We investigated the factors impacting their prognosis by the Log-rank test univariate analysis and multivariate COX regression analysis. Results HER2-positive patients treated with trastuzumab had a poor prognosis in pT_2-3(HR=2.10, P=0.003), pN_2-3(HR=2.81, P<0.001), and no endocrine therapy (HR=2.50, P<0.001), and that had a better prognosis combined with taxane or other chemotherapy regimens (HR=0.40, P=0.017). We divided the patients into two subgroups according to the status of lymph node metastasis, and we found that in the negative lymph nodes group the patients with pT_2-3 stage had poor prognosis (P=0.020), while the patients combined with taxane or other chemotherapy had better prognosis (P=0.032). In the positive lymph nodes group the patients with pT_2-3 stage and no endocrine therapy had poor prognosis (P=0.012, P=0.001). Conclusions The patients with HER2-positive breast cancer treated with trastuzumab can be managed in different categories, for individuals without lymph node involvement and small tumor sizes, combining therapy with non-anthracycline chemotherapy is preferable for achieving improved outcomes, for patients with lymph node metastasis and large tumor sizes, if chemotherapy options are available, it is more recommended to use an anthracycline-free regimen to ensure the same prognosis while reducing the harm caused by the toxic side effects of chemotherapy.

Key words: HER2-positive breast cancer, Trastuzumab, Lymph node metastasis, Prognosis

CLC Number:

R737.9

LI Yuefeng, HONG Jin, LI Zhian, RUAN Guodong, CHEN Weiguo. Prognostic analysis of the patients with HER2-positive breast cancer adjuvant treated with trastuzumab: a report of 1 246 cases[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 469-476.

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References 31

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Items	Total（%） (n=1 246)	lymph node metastasis		P value
Items	Total（%） (n=1 246)	No (n=776)	Yes (n=470)	P value
Age				0.363
<50	460(36.9)	294(37.9)	166(35.5)
≥50	786(63.1)	482(62.1)	304(64.7)
Menstrual state				0.572
Premenopause	519(41.7)	328(42.3)	191(40.6)
Postmenopaus	727(58.3)	448(57.7)	279(59.4)
Malignancy history				0.785
Yes	42(3.4)	27(3.5)	15(3.2)
No	1 204(96.6)	749(96.5)	455(96.8)
Surgical approach				<0.001
Breast-conserving	263(21.1)	201(25.9)	62(13.2)
Total mastectomy	983(78.9)	575(74.1)	408(86.8)
Pathology				<0.001
DCIS with microinfiltration	45(3.6)	40(5.2)	5(1.1)
IDC	1172(97.7)	712(91.8)	460(97.9)
others	29(2.3)	24(3.1)	5(1.1)
pT stage				<0.001
1	646(51.8)	470(60.6)	176(37.4)
2	576(46.2)	304(39.2)	272(57.9)
3-4	24(1.9)	2(0.3)	22(4.7)
Molecular typing				0.790
HER2 overexpression type	637(51.1)	399(51.4)	238(50.6)
Luminal B((HER2+)	609(48.9)	377(48.6)	232(49.4)
Histological grade				0.048
Ⅰ-Ⅱ	441(35.4)	285(36.7)	156(33.2)
Ⅲ	712(57.1)	425(54.8)	287(61.1)
NA	93(7.5)	66(8.5)	27(5.7)
Chemotherapy				<0.001
A&T	888(71.3)	456(58.8)	432(91.9)
T&O	358(28.7)	320(41.2)	38(8.1)
Radiotherapy				<0.001
Yes	657(52.7)	230(29.6)	427(90.9)
No	589(47.3)	546(70.4)	43(9.1)
Endocrine therapy				0.483
Yes	623(50.0)	382(49.2)	241(51.3)
No	623(50.0)	394(50.8)	229(48.7)

Feature	Univariate analysis（BCFI）	Univariate analysis（OS）
Feature	P value	P value
pT stage	<0.001	0.036
pN stage	<0.001	0.006
Molecular typing	0.001	0.182
Chemotherapy	<0.001	0.208
Endocrine therapy	<0.001	0.073
Radiotherapy	<0.001	0.209
Age	0.313	0.302
Menstrual state	0.827	0.616
History of malignancy	0.225	0.330
Surgical approach	0.955	0.474
Pathology	0.154	0.483
Histological grade	0.518	0.896

Feature	Multivariate analysis（BCFI）			Multivariate analysis（OS）
Feature	HR	95%CI	P value	HR	95%CI	P value
pT stage
1	1			1
2-3	2.10	1.29-3.40	0.003	1.69	0.70-4.06	0.244
pN stage
0	1			1
1	1.28	0.73-2.23	0.390	1.81	0.64-5.09	0.261
2-3	2.81	1.71-4.61	<0.001	4.48	1.86-10.82	0.001
Molecular typing					-
HER2 overexpression type	1
Luminal B（HER2+）	1.03	0.39-2.77	0.948
Chemotherapy					-
A&T	1
T&O	0.40	0.18-0.85	0.017
Endocrine therapy					-
Yes	1
No	2.50	1.59-3.94	<0.001
Radiotherapy					-
Yes	1
No	0.67	0.37-1.22	0.188

Feature	Univariate analysis P value	Multivariate analysis
Feature	Univariate analysis P value	HR	95%CI	P value
pT	0.003
1		1
2-3		2.36	1.15-4.88	0.020
Surgical approach	0.031
Breast-conserving		1
Total mastectomy		0.43	0.22-0.87	0.019
Radiotherapy	0.041
Yes		1
No		1.32	0.44-3.95	0.624
Chemotherapy	0.004
A&T		1
T&O		0.35	0.13-0.91	0.032
Endocrine therapy	0.063
Yes		1
No		2.19	1.06-4.52	0.034

Feature	Univariate analysis P value	Multivariate analysis
Feature	Univariate analysis P value	HR	95%CI	P value
pT	0.011
1		1
2-3		2.28	1.20-4.32	0.012
Endocrine therapy	0.001
Yes		1
No		2.65	1.48-4.74	0.001
Molecular typing	0.002
HER2 overexpression type		1
Luminal B（HER2+）		0.88	0.22-3.54	0.860