Clinicopathologic Characteristics and Prognosis of ERBB2-Low Breast Cancer Among Patients in the National Cancer Database.
Clinicopathologic Characteristics and Prognosis of ERBB2-Low Breast Cancer Among Patients in the National Cancer Database.
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DOI：
10.1001/jamaoncol.2022.7476
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发表时间：
2023-04-01
期刊：
影响因子：
28.4
通讯作者：
Howard, Frederick M. M.
中科院分区：
文献类型：
--
作者：
Peiffer, Daniel S. S.;Zhao, Fangyuan;Chen, Nan;Hahn, Olwen M. M.;Nanda, Rita;Olopade, Olufunmilayo I. I.;Huo, Dezheng;Howard, Frederick M. M.
无 erb-b2 受体酪氨酸激酶 2（ERBB2；以前的 HER2 或 HER2/neu）表达（ERBB2 阴性）和低水平 ERBB2 表达（ERBB2 低）的乳腺癌之间的人口统计学、临床病理特征和预后是否存在差异？在这项对来自美国国家癌症数据库的 1 136 016 名患者进行的队列研究中，与非西班牙裔白人患者相比，西班牙裔和非西班牙裔黑人患者中 ERBB2 低乳腺癌的比例略低。与 ERBB2 阴性癌症相比，ERBB2 低状态与总体生存率略有改善相关（5 年差异≤2%）。这项研究的结果表明，ERBB2 低和 ERBB2 阴性癌症的治疗反应和长期结果可能相似，并且不支持将 ERBB2 低乳腺癌分类为独特的疾病实体。鉴于有关 erb-b2 受体酪氨酸激酶 2（ERBB2；以前称为 HER2 或 HER2/neu）低乳腺癌预后的相互矛盾的结果，需要对 ERBB2 低乳腺癌与 ERBB2 阴性乳腺癌进行大规模、全国适用的比较。探讨 ERBB2 低乳腺癌在流行病学特征、预后和对新辅助化疗的反应方面是否是一种临床上独特的亚型。这项回顾性队列研究是使用国家癌症数据库进行的，包括 2010 年 1 月 1 日至 2019 年 12 月 31 日期间美国诊断为浸润性乳腺癌的 1 136 016 名患者，这些患者患有 ERBB2 阴性疾病，并且有免疫组织化学结果。 ERBB2低肿瘤被分类为免疫组织化学评分为1+，或原位杂交测试阴性的2+。数据分析时间为2021年11月1日至2022年11月30日。根据常规临床实践进行标准治疗。主要结局是 ERBB2 阴性乳腺癌与 ERBB2 低乳腺癌的总生存期 (OS)（以调整后风险比 (aHRs) 报告）和病理完全缓解（以调整后比值比 (aORs) 报告），控制了年龄、性别、种族和民族、Charlson-Deyo 合并症指数评分、治疗设施类型、肿瘤分级、肿瘤组织学、激素受体状态和癌症 阶段。该研究确定了 1 136 016 名患者（平均 [SD] 年龄为 62.4 [13.1] 岁；99.1% 为女性；78.6% 非西班牙裔白人），其中 392 246 名 (34.5%) 被诊断为 ERBB2 阴性乳腺癌，743 770 名 (65.5%) 被诊断为 ERBB2 低乳腺癌。 ERBB2 阴性组的平均 (SD) 年龄为 62.1 (13.2) 岁，ERBB2 低组的平均 (SD) 年龄为 62.5 (13.0) 岁。较高的雌激素受体表达与 ERBB2 低疾病发生率增加相关（aOR，每增加 10% 1.15）。与非西班牙裔白人患者（其中 66.1% 被诊断为 ERBB2 低乳腺癌）相比，非西班牙裔黑人 (62.8%) 和西班牙裔 (61.0%) 患者患有 ERBB2 低乳腺癌的人数较少，尽管在非西班牙裔黑人患者中，这是由三阴性乳腺癌发生率差异和其他混杂因素介导的。多变量分析显示，ERBB2 低疾病患者的病理完全缓解率略低于 ERBB2 阴性疾病患者（aOR，0.89；95% CI，0.86-0.92；P < .001）。 ERBB2 低状态还与 III 期（aHR，0.92；95% CI，0.89-0.96；P < .001）和 IV 期（aHR，0.91；95% CI，0.87-0.96；P < .001）三阴性乳腺癌的 OS 小幅改善相关，尽管这仅相当于2.0%（第三阶段）和 0.4%（第四阶段）增加 5 年操作系统。这项大规模回顾性队列分析发现 ERBB2 低乳腺癌和 ERBB2 阴性乳腺癌之间的预后差异极小。这些发现表明，展望未来，ERBB2 低乳腺癌的结果将由 ERBB2 导向的抗体药物偶联物驱动，而不是与低水平 ERBB2 表达相关的生物学特征的内在差异。这些发现并不支持将 ERBB2 低乳腺癌分类为一种独特的疾病实体。这项队列研究利用国家癌症数据库数据来调查与无 ERBB2 表达的乳腺癌相比，低 ERBB2 表达的乳腺癌是否是一种临床上不同的亚型，具有不同的流行病学特征、预后和对新辅助化疗的反应。
Do the demographics, clinicopathologic characteristics, and prognosis differ between breast cancers with no erb-b2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu) expression (ERBB2 negative) and those with low-level ERBB2 expression (ERBB2 low)? In this cohort study of 1 136 016 patients from the National Cancer Database in the US, the proportions of ERBB2-low breast cancer were slightly lower among Hispanic and non-Hispanic Black patients compared with non-Hispanic White patients. ERBB2-low status was associated with slightly improved overall survival (≤2% difference at 5 years) compared with ERBB2-negative cancer. The findings of this study suggest that treatment response and long-term outcomes may be similar in ERBB2-low and ERBB2-negative cancers and do not support the classification of ERBB2-low breast cancer as a unique disease entity. Given conflicting results regarding the prognosis of erb-b2 receptor tyrosine kinase 2 (ERBB2; formerly HER2 or HER2/neu)–low breast cancer, a large-scale, nationally applicable comparison of ERBB2-low vs ERBB2-negative breast cancer is needed. To investigate whether ERBB2-low breast cancer is a clinically distinct subtype in terms of epidemiological characteristics, prognosis, and response to neoadjuvant chemotherapy. This retrospective cohort study was conducted using the National Cancer Database, including 1 136 016 patients in the US diagnosed with invasive breast cancer from January 1, 2010, to December 31, 2019, who had ERBB2-negative disease and had immunohistochemistry results available. ERBB2-low tumors were classified as having an immunohistochemistry score of 1+, or 2+ with a negative in situ hybridization test. Data were analyzed from November 1, 2021, through November 30, 2022. Standard therapy according to routine clinical practice. The primary outcomes were overall survival (OS), reported as adjusted hazard ratios (aHRs), and pathologic complete response, reported as adjusted odds ratios (aORs), for ERBB2-negative vs ERBB2-low breast cancer, controlling for age, sex, race and ethnicity, Charlson-Deyo Comorbidity Index score, treatment facility type, tumor grade, tumor histology, hormone receptor status, and cancer stage. The study identified 1 136 016 patients (mean [SD] age, 62.4 [13.1] years; 99.1% female; 78.6% non-Hispanic White), of whom 392 246 (34.5%) were diagnosed with ERBB2-negative and 743 770 (65.5%) with ERBB2-low breast cancer. The mean (SD) age of the ERBB2-negative group was 62.1 (13.2) years and 62.5 (13.0) years for the ERBB2-low group. Higher estrogen receptor expression was associated with increased rates of ERBB2-low disease (aOR, 1.15 per 10% increase). Compared with non-Hispanic White patients, of whom 66.1% were diagnosed with ERBB2-low breast cancer, fewer non-Hispanic Black (62.8%) and Hispanic (61.0%) patients had ERBB2-low disease, although in non-Hispanic Black patients this was mediated by differences in rates of triple-negative disease and other confounders. A slightly lower rate of pathologic complete response was seen in patients with ERBB2-low disease vs patients with ERBB2-negative disease on multivariable analysis (aOR, 0.89; 95% CI, 0.86-0.92; P < .001). ERBB2-low status was also associated with small improvements in OS for stage III (aHR, 0.92; 95% CI, 0.89-0.96; P < .001) and stage IV (aHR, 0.91; 95% CI, 0.87-0.96; P < .001) triple-negative breast cancer, although this amounted to only a 2.0% (stage III) and 0.4% (stage IV) increase in 5-year OS. This large-scale retrospective cohort analysis found minimal prognostic differences between ERBB2-low and ERBB2-negative breast cancer. These findings suggest that, moving forward, outcomes in ERBB2-low breast cancer will be driven by ERBB2-directed antibody-drug conjugates, rather than intrinsic differences in biological characteristics associated with low-level ERBB2 expression. These findings do not support the classification of ERBB2-low breast cancer as a unique disease entity. This cohort study uses National Cancer Database data to investigate whether breast cancer with low ERBB2 expression is a clinically distinct subtype compared with breast cancer with no ERBB2 expression, with distinct epidemiological characteristics, prognosis, and response to neoadjuvant chemotherapy.
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影响因子：
64.8
作者：
Sammut SJ;Crispin-Ortuzar M;Chin SF;Provenzano E;Bardwell HA;Ma W;Cope W;Dariush A;Dawson SJ;Abraham JE;Dunn J;Hiller L;Thomas J;Cameron DA;Bartlett JMS;Hayward L;Pharoah PD;Markowetz F;Rueda OM;Earl HM;Caldas C
通讯作者：
Caldas C
HER2-低表达在激素受体阳性早期乳腺癌中的预后影响。
DOI：
10.1016/j.breast.2021.08.016
发表时间：
2021-12
期刊：
Breast (Edinburgh, Scotland)
影响因子：
--
作者：
Mutai R;Barkan T;Moore A;Sarfaty M;Shochat T;Yerushalmi R;Stemmer SM;Goldvaser H
通讯作者：
Goldvaser H
2010年至2015年美国不同种族/民族的乳腺癌亚型发病率和分布变化
影响因子：
13.8
作者：
Kong X;Liu Z;Cheng R;Sun L;Huang S;Fang Y;Wang J
通讯作者：
Wang J
影响因子：
3.7
作者：
Bilimoria KY;Stewart AK;Winchester DP;Ko CY
通讯作者：
Ko CY
影响因子：
45.3
作者：
Gianni, Luca;Llado, Anna;Baselga, Jose
通讯作者：
Baselga, Jose