Variation of the Prognostic Significance of HER-2 Expression in Breast Cancer According to Tumor Size

Swede, Helen; Moysich, Kirsten B.; Winston, Janet S.; Hurd, Thelma C.; Edge, Stephen B.; Romero‐Gutierrez, Maritza; Brooks, John S.; Michalek, Arthur M.

doi:10.1046/j.1524-4741.2003.09207.x

Cited by 11 publications

(11 citation statements)

References 22 publications

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“…We stratified analyses a priori by SEER summary stage of disease (local, regional, distant) because of the mixed evidence of prognostic value of HER2 status in node-negative patients. 28 Two forced models were constructed using the same variables included in the logistic regression. Survival time among patients who died was defined as months from date of diagnosis to date of death.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Prognostic Role of Triple-Negative Breast Cancer by Race: A Surveillance Study

Swede

Gregorio

Tannenbaum

et al. 2011

Clinical Breast Cancer

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A possible explanation for the relatively poor survival from breast cancer among blacks is the much higher rate of the adverse Triple-Negative sub-type. In a study of 1372 patients, blacks had twice the risk of death compared to whites among those with advanced cancer whether or not tumors were Triple-Negative. More research is still warranted to determine why blacks with advanced, but not local, breast cancer have a consistently higher rate of death. Introduction Emerging research suggests a substantially greater prevalence of the adverse triple-negative (TN) subtype (human epidermal growth factor receptor [HER]2−, estrogen receptor [ER]−, and progesterone receptor [PR])−) among black patients with breast cancer. No reports however have been generated from a statewide cancer registry. Patients and Methods The study consisted of all black patients (N = 643) and a random sample of white patients (n = 719) diagnosed with primary invasive breast cancer (2000–2003) listed in the National Cancer Institute–Surveillance Epidemiology and End Results (NCI-SEER) Connecticut Tumor Registry (CTR). HER2 status was obtained from pathology reports submitted to the registry. Remaining data were obtained from the registry database. Results TN tumors were more prevalent in black compared with white patients (30.8% vs. 11.2%, respectively; P < .001.) There was a 2-fold greater frequency of ER− and PR− phenotypes among black patients, but HER2 status did not differ by race. Patients with lobular cancer were less likely to have TN breast cancer compared with patients with ductal tumors (odds ratio [OR] = 0.23; 95% confidence interval [CI], 0.10–0.58). Among patients with regional disease, black patients exhibited increased risk of death (relative risk [RR] = 2.71; 95% CI, 1.48–4.97) independent of TN status. No survival disparity was found among patients with local disease. Discussion These registry-based data corroborate reports that TN breast cancer varies substantially by race and histologic subtype. A survival disparity among patients with advanced disease, but not local disease, casts some doubt on TN status as an explanation for differences. Conclusion More research is warranted to understand why black patients with advanced breast cancer may be at increased risk for death whether or not their tumors express the TN phenotype.

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Section: Methodsmentioning

confidence: 99%

Prevalence and Prognostic Role of Triple-Negative Breast Cancer by Race: A Surveillance Study

Swede

Gregorio

Tannenbaum

et al. 2011

Clinical Breast Cancer

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“…To date, no universally accepted markers for this group of patients have been isolated [5,20]. Recently, HER2/neu expression has attracted significant interest as a potential prognostic and [20,21]. In general, HER2/neu overexpression is correlated with tumor size or number of involved LNs and is more often observed in advanced breast cancer [21].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, HER2/neu expression has attracted significant interest as a potential prognostic and [20,21]. In general, HER2/neu overexpression is correlated with tumor size or number of involved LNs and is more often observed in advanced breast cancer [21]. Several studies support the prognostic significance of HER2/neu in LN-positive breast cancer [22,23].…”

Section: Discussionmentioning

confidence: 99%

Tissue microarray-based study of patients with lymph node-negative breast cancer shows that HER2/neu overexpression is an important predictive marker of poor prognosis

et al. 2009

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Background: Despite good prognosis in most cases of lymph node (LN)-negative breast cancer, individual patients may have markedly different clinical outcomes. Here, we investigated the prognostic significance of HER2/neu overexpression in these tumors. Materials and methods:We employed a tissue microarray to examine HER2/neu overexpression by immunohistochemical staining in 359 consecutive patients diagnosed with LN-negative breast cancer, who underwent surgery from January 1993 to December 1998.Results: HER2/neu overexpression was detected in 81 of 359 (23.1%) patients. The 10-year disease-free survival (DFS) values (81.2% versus 61.8%, P value 0.000) and overall survival (OS) rates (85.7% versus 63.9%, P value 0.000) were significantly different between cases with HER2/neu-negative or HER2/neu-positive tumors. After multivariate analysis, HER2/neu status and tumor size were identified as independent prognostic factors for 10-year OS. Moreover, HER2/neu overexpression was significantly associated with poorer clinical outcomes in an intermediate-risk group identified by the St Gallen classification (10-year DFS, 79.6% versus 61.8%, P value 0.000; 10-year OS, 84.7% versus 63.9%, P value 0.000). Conclusions:Our results show that HER2/neu overexpression is an important independent prognostic factor for LN-negative breast cancer cases and support the theory that more intensive adjuvant chemotherapy is required in the population with HER2/neu overexpression.

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“…35,36 The value of HER-2 amplification or overexpression as an independent prognostic factor in node-negative cases remains controversial. [37][38][39][40] Some authors have suggested that its prognostic significance seems to increase in lymph node-positive patients, 9 while others showed that HER-2/neu amplification identifies a poor prognosis in node-negative breast cancer. 38,41 In our study, we considered both lymph node-negative and -positive (metastatic) cases.…”

Section: Discussionmentioning

confidence: 99%

“…4 HER-2/neu amplification or overexpression is found in approximately 20% to 40% of primary invasive breast cancer cases. [5][6][7][8][9] It is possible to study both protein expression and gene amplification. The most common techniques are, respectively, immunohistochemistry and fluorescence in situ hybridization (FISH).…”

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HER-2/neu in Breast Cancer

Rossi¹,

Ubiali²,

Cadei³

et al. 2006

Applied Immunohistochemistry &Amp; Molecular Morphology

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HER-2/neu is a protooncogene frequently overexpressed in breast cancer. Fluorescence in situ hybridization (FISH) is a technique targeting the gene amplification, while immunohisto-chemistry detects the protein expression. Usually both are applied to paraffin-embedded tissue. The authors studied HER-2 by FISH and immunohistochemistry (HercepTest) in 81 breast carcinomas. The results showed an overall concordance (correlation coefficient 0.64). In all cases with HercepTest score 0 and 1+, nonamplification of the gene was observed. Gene amplification was found in 20% of cases with a 2+ score and in 77.78% of cases with a 3+ score. Data described in literature for 3+ carcinomas showed a 3% to 10% discrepancy between protein expression and gene amplification, while in this study this difference was up to 22.22%. As a consequence, even if it is usually considered important to analyze only 2+ cases by FISH, 3+ scores nonamplified for HER-2/neu may be a new, interesting subset. Furthermore, the authors investigated the two-variables correlation between chromosome 17 copy number, protein over-expression, gene amplification, and presence of metastatic lymph nodes. Interesting results came from the correlation between the HercepTest score and the HER-2/neu gene amplification evaluation, HercepTest and chromosome 17 aneusomy, and gene amplification and lymph nodes status. In conclusion, the FISH technique can be an important and useful diagnostic tool to integrate the results of the HercepTest and to select patients for immunotherapy.

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Variation of the Prognostic Significance of HER-2 Expression in Breast Cancer According to Tumor Size

Cited by 11 publications

References 22 publications

Prevalence and Prognostic Role of Triple-Negative Breast Cancer by Race: A Surveillance Study

Prevalence and Prognostic Role of Triple-Negative Breast Cancer by Race: A Surveillance Study

Tissue microarray-based study of patients with lymph node-negative breast cancer shows that HER2/neu overexpression is an important predictive marker of poor prognosis

HER-2/neu in Breast Cancer

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