title: Moderate HER2 expression as a prognostic factor in hormone receptor positive breast cancer.
abstract: Overexpression and/or amplification of human epidermal growth factor receptor 2 (HER2) is associated with poor prognosis in breast cancer and predicts response to anti-HER2 therapy in breast cancer. The prognostic relevance of moderate expression of HER2 is unclear. Data of 9872 patients with primary nonmetastatic breast cancer from the cancer registries of Magdeburg and Halle, Germany, were analyzed retrospectively. A total of 5907 patients with complete data sets including follow-up were eligible for analysis. HER2 status was determined as recommended by international guidelines. Of 5907 patients investigated, 5023 (68.4%) had HER2 0 and 1+ expression and 884 (12.0%) had HER2 (2+)/HER2- expression. Patients with hormone receptor positive (HR+) and HER2 (2+) tumors had a shorter median disease-free survival (DFS; P<0.0001) and breast cancer specific survival (BCSS; P=0.019) than HR+ patients with HER2 (0/1+) tumors. Among patients with HR- breast cancer there was no significant difference between HER2 (2+) and HER2 (0/1+) tumors. In multivariate analysis after adjustment for other prognostic factors, HER2 (2+) status remained an unfavorable prognostic factor for DFS (hazard ratio (HR)=1.217, 95% CI=1.052-1.408; P=0.008) but not for BCSS (HR=1.045, 95% CI=0.926-1.178; P=0.474). The HER2 (2+) status is an unfavorable prognostic factor for survival of patients with HR+ breast cancer. The impact of anti-HER2 therapy in this group of patients should be evaluated.
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany.
authors.forename: Holm
authors.initials: H
authors.lastname: Eggemann
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Ignatov
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Burger
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany.
authors.forename: Eva Johanna
authors.initials: EJ
authors.lastname: Kantelhardt
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Fettke
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Thomssen
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany.
authors.forename: Serban Dan
authors.initials: SD
authors.lastname: Costa
authors.affiliation: Department of Obstetrics and GynecologyInstitute of Biometry and Medical InformaticsOtto-von-Guericke University, Gerhart-Hauptmann Straße 35, 39108 Magdeburg, GermanyDepartment of GynecologyMartin Luther University, Halle (Saale), Germany atanas.ignatov@med.ovgu.de.
authors.forename: Atanas
authors.initials: A
authors.lastname: Ignatov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human
keywords: HER2; HER2 2+; HER2 score; breast cancer