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. 2013 Jun;8(3):208-14.
doi: 10.1159/000352094.

Association of HER2 Overexpression and Prognosis in Small (T1N0) Primary Breast Cancers

Joachim Rom  1 , Claudia Schumacher  2 , Oleg Gluz  3 , Josef Höfler  4 , Sebastian Eidt  5 , Christoph Domschke  1 , Frederik Marmé  6 , Ulrike Nitz  3 , Christof Sohn  1 , Andreas Schneeweiss  6
Affiliations

Association of HER2 Overexpression and Prognosis in Small (T1N0) Primary Breast Cancers

Joachim Rom et al. Breast Care (Basel). 2013 Jun.

Abstract
in English, German

Background: There is some controversy regarding the precise role and need for adjuvant therapy in patients with pT1a/pT1bN0 breast cancer, although studies have indicated that a HER2-positive status is one of the most powerful poor prognostic factors.

Patients and methods: We retrospectively evaluated disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) among 960 patients diagnosed between 2000 and 2008 with T1N0 primary breast cancer treated at 3 German centers, and determined prognostic risk factors. Univariate analysis was used to determine associations with potential risk factors.

Results: With a median follow-up of 23 months, DFS was 94.8%, DDFS 96.3%, and OS 97.5%. Risk factors for decreased 1-year DFS were: peritumoral lymphatic invasion (L1) (p = 0.031), negative hormone receptor status (p = 0.003), non-use of hormonal therapy (p = 0.001), and a positive HER2 status (p = 0.003). Amongst the HER2-positive patients only 2.7% (n = 1/37) of those treated with trastuzumab had a DFS event compared with 20% (n = 10/50) without trastuzumab.

Conclusion: Patients with HER2-positive T1 breast cancer should be considered for inclusion in prospective trials of trastuzumab in combination with chemotherapy to determine the risk-to-benefit ratio and association with other prognostic factors.

Hintergrund: Die Bedeutung und der Nutzen einer adjuvanten Therapie bei Patientinnen mit einem pT1a/pT1bN0-Mammakarzinom wird kontrovers diskutiert. In einigen Studien konnte ein positiver HER2-Status als einer der stärksten prognostischen Faktoren nachgewiesen werden. Patientinnen und Methoden: In dieser Studie wurde retrospektiv an 3 deutschen Brustzentren das krankheitsfreie Überleben (DFS), das distant krankheitsfreie Überleben (DDFS) und das Gesamtüberleben (OS) von 960 Patientinnen, die zwischen 2000 und 2008 an einem primären Mammakarzinom < 2 cm (T1N0) erkrankten, ausgewertet. Zusätzlich wurden die prognostischen Faktoren untersucht. Der Zusammenhang mit potentiellen Risikofaktoren wurde durch univariate Analysen untersucht. Ergebnisse: Die mediane Nachbeobachtungszeit betrug 23 Monate, DFS war 94,8%, DDFS 96,3% und OS 97,5%. Risikofaktoren für ein kürzeres 1-Jahres-DFS waren: peritumorale lymphatische Invasion (L1) (p = 0,031), negativer Hormonrezeptorstatus (p = 0,003), keine adjuvante hormonelle Therapie (p = 0,001) und ein positiver HER2-Status (p = 0,003). Bei Patientinnen, die mit Trastuzumab behandelt wurden, trat nur bei 2,7% (n = 1/37) ein DFS-Ereignis auf, bei Patienten ohne Trastuzumab-Therapie war dies bei 20% (n = 10/50) der Fall. Schlussfolgerung: Patienten mit einem HER2-positiven Mammakarzinom < 2 cm sollten in prospektive Studien eingeschlossen werden, um die Bedeutung der Trastuzumab-Therapie in Kombination mit Chemotherapie, das Nutzen-Risiko-Verhältnis und die Bedeutung anderer Riskiofaktoren untersuchen zu können.

Keywords: Adjuvant treatment; Disease-free survival; HER2/neu; High-risk breast cancer; Trastuzumab.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier plot of disease-free survival for patients with T1N0 breast tumors.
Fig. 2
Fig. 2
Kaplan-Meier plot of disease-free survival for patients with T1N0 breast tumors according to HER2 status: HER2-negative (green) and HER2-positive (red).
See this image and copyright information in PMC

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