Significant increased recurrence rates among breast cancer patients with HER2-positive, T1a,bN0M0 tumors.

Abstract

#701 Background: Controversy surrounds the prognosis of breast cancer patients with T1a,bN0M0 tumors following locoregional therapy and the need for adjuvant systemic therapy, especially for HER2+ disease. The purposes of the study were to determine the recurrence-free survival (RFS), and distant recurrence-free survival (DRFS) in small HER2+ tumors compared with hormone receptor ( HR)+ and triple receptor- (TN) tumors.
 Methods: Stage T1a,bN0M0 breast cancers diagnosed between 1973-2003 were reviewed by dedicated breast pathologists. HER2+ tumors were defined as 3+ by IHC or gene amplification. Patients were categorized into 3 groups:TN (ER-, PR-and HER2-), HER2+ (regardless of HR status) and HR+ (HER2-). RFS and DRFS were estimated by the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards models were fit to determine the association of each group with the risk of recurrence after adjustment for other characteristics.
 Results: Of the 1796 patients, 427 were excluded from the analysis due to being male (2), lack of receptor information (249), and adjuvant chemotherapy (176) leaving 1369 pts for analysis. Median age was 57 years,(range, 26-88). There were 381(28%) T1a and 988(72%) T1b tumors; HR+ 68%, TN 23%, HER2+ 9%. Patients who had HER2+ breast cancer tended to be younger,(p=0.001); have more T1a tumors, (p=0.001); and have higher nuclear grade,(p<0.001). At a median follow-up of 74 months(range 1-350), there were 160 recurrences and 77 distant metastases. Five and 10-year RFS and DRFS are summarized in the table. After adjustment for other characteristics, patients with HER2+ breast cancer had a significantly worse RFS (HR: 5.19, 95% CI: 3.21-8.39, p<0.0001) and DRFS (HR: 4.66, 95% CI: 2.47-8.80, p<0.0001) compared to patients with HR-positive breast cancer.
 Conclusions: Breast cancer patients with HER2+ T1a,bN0M0 tumors have a significant risk of relapse and should be considered candidates for adjuvant systemic therapy including anti-HER2 agents.
 
 Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 701.

Prognostic Significance of HER-2/neu and Survival of Breast Cancer Patients Attending a Specialized Breast Clinic in Kolkata, Eastern India

“…HER-2 marker had predicting prognosis and outcome of breast cancer (Payne et al, 2008). HER-2 status was shown a significant predictor of disease-free survival in node -negative small size tumors (Rakkhit et al, 2009). High risk of relapse for patients who had HER-2 positive with node negative or small size tumor (Ana et al, 2010).…”

Poor survival outcomes in HER2-positive breast cancer patients with low-grade, node-negative tumours

“…In a study of over 2000 node-negative patients (Chia et al, 2008), HER2 status was shown to be an independent prognostic factor for disease-free survival in ER-negative patients. Rakkhit et al (2009) have shown HER2 to be a significant predictor of disease-free survival in a group of almost 1000 node-negative tumours o1 cm in size.…”

Estrogen/Progesterone Receptor Negativity and HER2 Positivity Predict Locoregional Recurrence in Patients With T1a,bN0 Breast Cancer

“…Previous studies, including recent work by our group, have correlated biomarker status with rates of survival and distant recurrence (18). However, fewer studies have examined these biomarkers as predictors of locoregional recurrence (LRR).…”