Clinical features of patients with HER2-positive breast cancer and development of a nomogram for predicting survival

Abstract

Background Different estrogen receptor (ER) and progesterone receptor (PR) expression patterns have important biological and therapeutic implications in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, little is known about hormone receptor (HR)-positive and triple-positive subtypes, making therapy selection and survival prognosis difficult. This study investigated the clinical characteristics and nomogram-predicted survival of patients with HER2-positive breast cancer. Materials and methods Data on patients with HER2-positive breast cancer were retrieved from the Surveillance, Epidemiology, and End Results database. Comparisons were carried out between single HR-positive and double HR-positive/double HR-negative subtypes. A nomogram-based model of predicted outcomes was developed. Results This cohort study included 34 819 patients with breast cancer (34 606 women and 213 men). Single HR-positive and double HR-positive/double HR-negative subtypes showed distinct clinicopathological characteristics. Multivariable Cox regression analysis showed that patients with ER-positive/PR-negative/HER2-positive [hazard ratio (HR) = 1.24; 95% confidence interval (CI): 1.14-1.39], ER-negative/PR-positive/HER2-positive (HR = 1.56; 95% CI: 1.23-1.97), and ER-negative/PR-negative/HER2-positive (HR = 1.56; 95% CI: 1.43-1.70) subtypes had worse breast cancer-specific survival than patients with the triple-positive subtype. Thirteen clinical parameters were included as prognostic factors in the nomogram: age, sex, race, grade, histology type, bone, brain, liver, and lung metastasis, TNM (tumor–node–metastasis) staging, and molecular subtype. The C-index was 0.853 (95% CI: 0.845-0.861). Calibration plots indicated that the nomogram-predicted survival was consistent with the recorded 3-year and 5-year prognoses. Conclusions Significant differences in survival rates were observed between single HR-positive and double HR-positive/double HR-negative subtypes. A nomogram accurately predicted survival. Different treatment strategies may be required for HER2-positive patients with single HR-positive and double HR-positive tumors to ensure optimal treatment and benefits.

Mining TCGA Database for Genes with Prognostic Value in Breast Cancer

“…Tumor subtypes were determined based on ER, PR, and HER2 expression profiles after establishing the positivity threshold values for these genes by Gaussian-deconvolution ( Figure 2 A–C). Of the 301 tumor tissues analyzed, the positivity rates were 73.42% for ER, 57.8% for PR, and 10.96% for HER2, in line with previous reports [ 18 , 19 ]. Based on these genes, tumor types were attributed: 68.4% of all tumors were Luminal A subtype, 6% Luminal B, 5% HER2 enriched, and 20.6% Triple Negative.…”

A Novel Prognostic Nomogram for Predicting Survival of Hormone Receptor-Positive and HER2 Negative Advanced Breast Cancer Among the Han-Population

“…R. Largillier et al ( 16) used a Cox proportional hazards model to identify age, the number of positive lymph nodes, adjuvant chemotherapy, and site of metastasis as independent predictors of stage IV BC patients' OS. Furthermore, liver metastasis, brain metastasis, lung metastasis, high histological grade, and large tumor size were reported to be associated with poor survival (15,18,23). However, all factors mentioned above did not have a prognostic effect on HR +/HER2-ABC patients' OS in our research results.…”

Analysis of the clinicopathological characteristics and prognosis of triple-positive breast cancer and HER2-positive breast cancer—A retrospective study

“…Larger tumors are less favorable for patients who wish to preserve their breasts and may often require patients to receive chemotherapy prior to surgery to shrink the tumor before surgery. In addition, one study ( 15 ) found that patients with HR-negative/HER2-positive tumors had more aggressive clinical features, including tumor stages III-IV, T stages 2-4, N stages 1-3, and M stage 1 including brain, liver, and lung metastases, clinical research revealed that BC metastasized mostly to the lung, bone, and liver via circulatory system ( 16 ); In contrast, triple positivity was associated with milder tumor behavior. These results suggest that triple-positive tumors are an independent biological subtype.…”