Clinical characteristics and predictive models of HER2-low breast cancer patients who only received adjuvant chemotherapy: a real-world retrospective multicenter study.

Journal: NPJ precision oncology
Published Date: Jul 1, 2025

Abstract

HER2-low positivity is reported to play substantial role in neoadjuvant chemotherapy for breast cancer, but its role in adjuvant chemotherapy remains unclear. We aim to explore the role of HER2-low positivity in the breast cancer patients who only received adjuvant chemotherapy. We evaluated 3214 patients from SRRSH Hospital and 16,273 patients from CHLP Hospital. All the patients were diagnosed as primary breast cancer who only received adjuvant chemotherapy. HER2-status was defined according to ASCO/CAP guidelines. Multivariable Cox models and machine learning models were applied in the analysis of overall survival. A total of 1009 HER2-zero, 1399 HER2-low and 806 HER2-positive patients were included in SRRSH cohort, while there were 5662 HER2-zero, 6471 HER2-low and 4140 HER2-positive patients in CHLP cohort. HER2-low patients showed significant better OS and reduced death risk compare to HER2-zero patients in both SRRSH (log-rank p = 0.033, HR = 0.62, 95% CI 0.39-0.97, p = 0.037) and CHLP cohort (log-rank p < 0.001, HR = 0.63, 95% CI 0.55-0.73, p < 0.001). In subgroup analysis, HER2-low patients had significantly reduced risk of death compare to HER2-zero patients in hormonal receptor-positive subset in both cohorts, but not in hormonal receptor-negative subset. MLP model demonstrated the best performance among all the predictive models in both cohorts. Our study indicated that HER2-low patients had better survival compare to HER2-zero patients in adjuvant chemotherapy only setting. We emphasized the significance of HER2 status in adjuvant setting in BC, implying more precise diagnostic and therapeutic strategies in future.

Authors

  • Qinchuan Wang
    Department of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. wangqinchuan@zju.edu.cn.
  • Yuying Wang
    Data Mining Research Center, Xiamen University, Xiamen, 361005, Fujian, China.
  • Zikang Chen
    College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
  • Yuqing Chao
    School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
  • Lin Chen
    College of Sports, Nanjing Tech University, Nanjing, China.
  • Wenjing Li
    Department of Allergy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
  • Xia Yang
    From the Department of Integrative Biology and Physiology, University of California, Los Angeles (Y.Z., Q.M., X.Y.); and Target Sciences Computational Biology (US), GSK, King of Prussia, PA (J.C., J.M.F., D.K.R.). xyang123@ucla.edu deepak.k.rajpal@gsk.com.
  • Zhinong Jiang
    Department of Pathology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
  • Xiaoyan Li
    Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China.
  • Bo Gao
  • Wenxian Hu
    Department of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
  • Jichun Zhou
    Department of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
  • Linbo Wang
    Institute of Science and Technology for Brain-Inspired Intelligence, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China. linbowang@fudan.edu.cn.
  • Haitao Li
    Faculty of Material Science and Chemistry, China University of Geosciences, Wuhan 430074, PR China.
  • Jun Zhang
    First School of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
  • Qiong Ding
    Department of General Surgery, People's Hospital of Putuo District, Zhoushan, Zhejiang, China.
  • Xudong Lv
    School of Instrumentation Science and Engineering, Harbin Institute of Technology, Harbin 150001, China.
  • Hao Zhang
    College of Mechanical and Electrical Engineering, Henan Agricultural University, Zhengzhou, 450002, China.
  • Heming Zheng
    Department of Surgical Oncology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

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